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[Main List]
Fact Sheets
What are Black Men’s HIV Prevention Needs?
http://www.caps.ucsf.edu/pubs/FS/blackmen.php
What Are Men Who Have Sex with Men (MSM)'S HIV Prevention Needs? Center for AIDS Prevention Studies, University Of California, San Francisco (CAPS, UCSF), revised 12/00
http://www.caps.ucsf.edu/pubs/fs/msmrev.php
Articles and Presentations
Sexual Risk Behaviors Among HIV-Positive Black Men Who Have Sex With Women, With Men, or With Men and Women: Implications for Intervention Development
Pilgrim S. Spikes 1*, David W. Purcell 2, Kim Williams 1, Ying Chen 3, Helen Ding 1, Patrick S. Sullivan 4
American Journal of Public Health, 1st look pubs updated April 16, 2009 http://www.ajph.org/first_look.shtml
AJPH published April 16, 2009, 10.2105/AJPH.2008.144030 [Abstract] [PDF]
E-mail: pspikes@cdc.gov
Abstract
Objectives. We compared demographics and sexual and drug risk behaviors among HIV-positive Black men who have sex with women only, with men only, or with men and women to assess differences among and between these groups.
Methods. We analyzed cross-sectional data from the Supplement to HIV and AIDS Surveillance Project for 2038 HIV-positive Black men who reported being sexually active. We classified the participants by their reported sexual behaviors in the past year: intercourse with women (n=1186), with men (n=741), or with men and women (n=111).
Results. Respondents whose sexual partners were both men and women reported more noninjection drug use, sexual exchange, and sexual partners than did the other 2 groups. Bisexual respondents were also more likely than were heterosexuals to report unprotected intercourse with a steady female partner and were more likely than were both other groups to report having steady partners of unknown HIV serostatus and using drugs during their last sexual episode.
Conclusions. HIV-positive Black men with both male and female sexual partners engaged in more sexual and drug risk behaviors than did their heterosexual and homosexual peers. More information concerning the prevention needs of behaviorally bisexual HIV-positive Black men is needed.
HIV Prevention for Black Men Who Have Sex with Men in the United States
John L. Peterson 1* Kenneth T. Jones 2
American Journal of Public Health, 1st look pubs updated April 16, 2009 http://www.ajph.org/first_look.shtml
AJPH published April 16, 2009, 10.2105/AJPH.2008.143214 [Abstract] [PDF]
Email: jpeterson@gsu.edu
Abstract
The HIV/AIDS epidemic has exacted a devastating toll upon Black men who have sex with men (MSM) in the United States, and there is a tremendous need to escalate HIV-prevention efforts for this population.
The social context in which Black MSM experience the impact of racism and heterosexism strongly affects their risk for HIV infection; thus, HIV-prevention research focused on Black MSM should focus on contextual and structural factors. There is a pronounced lack of community-level HIV-intervention research for Black MSM, but effective preliminary strategies involve adapting existing effective models and tailoring them to the needs of Black MSM.
Future research should develop new, innovative approaches, especially structural interventions, that are specifically targeted toward HIV prevention among Black MSM.
Learning From Successful Interventions: A Culturally Congruent HIV Risk–Reduction Intervention for African American Men Who Have Sex With Men and Women
John K. Williams 1*, Hema C. Ramamurthi 1, Cleo Manago 2, Nina T. Harawa 3
AJPH published April 16, 2009, 10.2105/AJPH.2008.140558 [Abstract] [PDF] keoniwmd@aol.com
Abstract Few HIV prevention interventions have been developed for African American men who have sex with men or who have sex with both men and women. Many interventions neglect the historical, structural or institutional, and sociocultural factors that hinder or support risk reduction in this high-risk group.
We examined ways to incorporate these factors into Men of African American Legacy Empowering Self, a culturally congruent HIV intervention targeting African American men who have sex with men and women.
We also studied how to apply key elements from successful interventions to future efforts. These elements include having gender specificity, a target population, a theoretical foundation, cultural and historical congruence, skill-building components, and well-defined goals.
Public Health Responses to the HIV Epidemic Among Black Men Who Have Sex With Men:A Qualitative Study of US Health Departments and Communities
Patrick A. Wilson 1* Terrance E. Moore 2
AJPH published April 16, 2009, 10.2105/AJPH.2008.140681 [Abstract] [PDF] pw2219@columbia.edu
Abstract
In the United States, Black men who have sex with men (MSM) are disproportionately affected by HIV/AIDS. Thus, there is a need to understand the challenges facing health departments and community-based organizations responding to the HIV epidemic among this population. We interviewed 71 AIDS program directors, health department staff, and leaders of community-based organizations in 9 states and the District of Columbia. Participants identified psychosocial factors, a lack of capacity-building efforts, and stigma as barriers to HIV prevention responses targeting Black MSM. Participants identified culturally competent staff and culturally sensitive interventions as facilitating prevention responses. To ensure that HIV/AIDS interventions targeting Black MSM are effective, it is imperative to solicit the perceptions of frontline workers in health departments and community-based organizations.
History of Childhood Sexual Abuse and Unsafe Anal Intercourse in a 6-City Study of HIV-Positive Men Who Have Sex With Men
Seth L. Welles 1*, A. Cornelius Baker 2, Michael H. Miner 3, David J. Brennan 4, Scott Jacoby 3, B.R. Simon Rosser 3
AJPH published April 16, 2009, 10.2105/AJPH.2007.133280 [Abstract] [PDF] slw58@drexel.edu
Abstract
Objectives. We assessed rates of childhood sexual abuse and its demographic and mental health correlates among HIV-positive men who reported unsafe anal intercourse with other men in the past year.
Methods. We conducted a cross-sectional analysis of baseline data from 593 HIV-positive men who have sex with men enrolled in the Positive Connections intervention.
Results. Childhood sexual abuse was reported by 47% of participants; 32% reported frequency as often or sometimes. Men reporting abuse were more likely to be Latino (odds ratio [OR]=2.6; 95% confidence interval [CI]=1.6, 4.2; P<.001) or African American (OR=1.8; 95% CI=1.2, 2.7; P=.005) than White. Among those who were abused, more frequent abuse was associated with more sexual contacts (for each, rate ratio [RR]=1.3; P<.001) and unsafe anal intercourse (often, RR=1.5; sometimes, RR=2.0; P<.001) compared with men who were not abused.
Conclusions. History of childhood sexual abuse is highly prevalent among HIV-positive men who engage in risky sexual behavior with other men and appears to be more common among men of color. Our findings suggest that abuse is associated with a significantly increased risk of sexually transmitted infections.
Beyond the Down Low: Sexual Risk, Protection, and Disclosure Among At-Risk Black Men Who Have Sex with Both Men and Women (MSMW).
Brian Dodge, William L. Jeffries, Theo G. M. Sandfort.
Archives of Sexual Behavior | Volume: 37 | Issue: 5 | Pps: 683-696
http://www.springerlink.com/content/n672233371101622/
Little information is available about sexual risk, protective, and disclosure practices among Black bisexually active men and how these may be amenable to intervention when necessary. In-depth interviews were conducted with 30 at-risk urban Black men who have sex with both men and women (MSMW). Participants reported protecting themselves and their partners through routine HIV testing, using condoms consistently, engaging in strategic positioning during sexual activity, and limiting the number of sexual partners. In addition, they described several reasons for not using protection, including not having condoms available, enjoying sexual activity more without condoms, and perceiving female partners to be “safer” than male partners. Disclosure of bisexuality was complex and reportedly difficult, in particular to female and gay-identified male partners. Future interventions must not only build protection and disclosure skills among MSMW, but also increase broader social awareness and acceptance of male bisexuality.
Sexual Behavior, Sexual Identity, And Substance Abuse Among Low-Income Bisexual And Non-Gay-Identifying African American Men Who Have Sex With Men.
Arch Sex Behav. 2008 Jun 11. [Epub ahead of print]
Harawa NT, Williams JK, Ramamurthi HC, Manago C, Avina S, Jones M.
Department of Research, Charles R. Drew University, Los Angeles, USA, ninaharawa@cdrewu.edu
Researchers examined the role of drug use and addiction in same-sex sexuality among non-gay-identifying African American men who have sex with men or with both men and women (MSM/MSMW). Between July 2005 and February 2006, seven focus groups were conducted with 46 predominately low socioeconomic status African American MSM/MSMW. A total of 29 men self-identified as HIV-infected and 17 self-identified as uninfected. Alcohol, crack cocaine, and crystal methamphetamine were the primary drugs mentioned by participants. Drug use was identified as playing a central role in same-sex sexuality for many African American MSM/MSMW. Participants described alcohol use and drug transactions, use, and addiction as motivating sex with men, allowing and rationalizing same-sex activity and unprotected sex, and facilitating access to male sex partners. Some of those in treatment for substance abuse indicated that a readiness to admit their same-sex activity and come to terms with their homosexuality/bisexuality was necessary for recovery. Because successful engagement of non-gay-identifying African American MSM/MSMW is essential to the reduction of HIV transmission and substance abuse in Black communities, findings call for drug treatment approaches that acknowledge and accept diverse sexuality in clients.
Qualitative Findings from Men of African American Legacy Empowering Self (MAALES) Project: Sex, Sexual Identity and Substance Abuse among African American Men who have Sex with Men
John K. Williams, MD
Department of Psychiatry & Biobehavioral Sciences, UCLA
September 22, 2008
http://www.uclaisap.org/slides/presentations-psattc-sarc-2008-2007.html
Illicit drug use among MSM is an important HIV risk factor. Prevalence rates of substance use at MSM circuit parties were significantly related to high-risk use of ecstasy and ketamine. African Americans have reported slightly higher rates of substance use, and more frequent and more sever consequences, including poorer physical health outcomes and more sever social problems. African American MSMs reported specifically using marijuana and non-injected crack cocaine more frequently than MSMs of other ethnicities. Understanding the psychosocial and cultural issues influencing drug use and sexual behavior and identity among African American MSMs is essential to HIV risk reduction. A better understanding of sexual identity among African American men within a sociocultural and developmental framework is needed.
Research needed to more effectively combat HIV among African-American men who have sex with men
Bing EG, Bingham T, Millett GA.
Drew CARES & Institute for Community Health Research, Charles Drew University of Medicine and Science, Los Angeles, CA 90059, USA. eric.g.bing@gmail.com
J Natl Med Assoc. 2008 Jan;100(1):52-6.
http://www.ncbi.nlm.nih.gov/pubmed/18277808?ordinalpos=9&itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_DiscoveryPanel.Pubmed_ Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed
It is estimated that nearly half of all African-American men who have sex with men (AAMSM) living in major U.S. cities are already infected with HIV. Without a substantial and committed investment in research in HIV prevention among AAMSM and subsequent evidence-based policies and community programs, it is unlikely that we will ever be able to curtail the HIV epidemic among African Americans in general, regardless of gender, age or sexual orientation. In this paper, we briefly review what is known and what research questions remain in order to curtail the epidemic among AAMSM. Finally, we provide recommendations for future research that include the: 1) development of a national cohort of young AAMSM to prospectively study biological, behavioral, social and contextual factors that place AAMSM at risk for infection with HIV and other STDs; 2) adapting existing interventions in HIV prevention to the unique characteristics of AAMSM and evaluating their effectiveness; 3) evaluating factors such as intracommunity and familial discrimination against AAMSM that may lead to lack of disclosure; and 4) enhancing our understanding of how cultural and social factors can be used in a positive and self-affirming way to strengthen HIV prevention and care for AAMSM.
PMID: 18277808 [PubMed - indexed for MEDLINE]
Circumcision Status and HIV Infection Among Black and Latino Men Who Have Sex With Men in 3 US Cities.
By Millett GA, Ding H, Lauby J, et al
To examine characteristics of circumcised and uncircumcised Latino and black men who have sex with men (MSM) in the United States and assess the association between circumcision and HIV infection. Using respondent-driven sampling, 1154 black MSM and 1091 Latino MSM were recruited from New York City, Philadelphia, and Los Angeles. J Acquir Immune Defic Syndr. 2007 Dec 15;46(5):643-650.
Love, Sex, and Masculinity in Sociocultural Context -- HIV Concerns and Condom Use among African American Men in Heterosexual Relationships
By Lisa Bowleg, University of Rhode Island
African American men in heterosexual relationships are virtually invisible in the theoretical and empirical psychological HIV/AIDS literature. This article posits that two theoretical frameworks—masculinity ideologies (MI) and sociocultural context—are important for comprehending Black men’s condom use.
The Influence of Dual-Identity Development on the Psychosocial Functioning of African-American Gay and Bisexual Men
By Isiaah Crawford, Loyola University of Chicago; Kevin W. Allison, Virginia Commonwealth University; Brian D. Zamboni, Loyola University of Chicago; and Tomas Soto, the CORE Center, Chicago, Ill.
To examine the influence of racial-ethnic and sexual identity development on the psychosocial functioning of African-American gay and bisexual men (AAGBM). Men and Masculinities. October 2004 pages 166-186
Roundtable: Male Circumcision and HIV Prevention: Is There Really Enough of the Right Kind of Evidence?
By Gary W Dowsett and Murray Couch
The discourse on HIV prevention at the XVI International Conference on AIDS in Toronto in August 2006 focused on the recently coined notion of “prevention technologies” which, while not including behaviour change, does include cervical barriers, pre-exposure prophylaxis with antiretroviral drugs, herpes suppression, microbicides, HIV vaccines, and as a newcomer to the list and, lauded as having most immediate promise, male circumcision. Deploying a very masculinist metaphor, male circumcision was often hailed at the Toronto conference as the newest “weapon in the arsenal.” Such a narrowly conceived range of biomedical prevention strategies, and their rendition as “technologies,” resonates with discourses now dominating the international HIV/AIDS field that favour medical intervention and morally sanctioned control over community mobilisation and activism for establishing and sustaining changes in behaviour. Reproductive Health Matters May 2007 (Vol. 15, Issue 29, Pages 33-44)
Higher Prevalence Of Childhood Sexual Abuse Among Latino Men Who Have Sex With Men Than Non-Latino Men Who Have Sex With Men: Data From the Urban Men’s Health Study
By Sonya Grant Arreola, Torsten B. Neilands, Lance M. Pollack, Jay P. Paul and Joseph A. Catania
The prevalence of childhood sexual abuse among Latino adult men who have sex with men who live in the US was estimated because a history of childhood sexual abuse increases HIV sexual risk behaviors and other negative health outcomes in adulthood. The Urban Men’s Health Study is a random-digit telephone probability survey of 2881 adult men who have sex with men (MSM) aged 18 years or older residing in San Francisco, New York, Los Angeles, and Chicago. Self-reported history of childhood sexual abuse was the main outcome measure gathered from 2692 MSM. Childhood Abuse and Neglect Received 31 March 2003; received in revised form 25 August 2004; accepted 9 September 2004.
Our lives: An examination of sexual health issues using photovoice by non-gay identified African American men who have sex with men.
By Mamary E, McCright J, Roe K. Department of Health Science, San José State University, California
African American men who have sex with men and who do not identify as gay are at high risk for HIV infection. This paper presents the results of the photovoice component, a participatory action research method, of a two-tiered qualitative study design that explored the perceptions of non-gay identified African American men who have sex with men living or working in the San Francisco Bay Area regarding the social, cultural, community, and family influences associated with their HIV risk and their general sexual health. Cult Health Sex. 2007 Jul-Aug; 9 (4):359-70.
Perceptions Towards Condom Use, Sexuality Activity, and HIV Disclosure Among HIV-Positive African American Men Who Have Sex with Men; Implications for Heterosexual Transmission
By Harawa NT, Williams JK, Ramamurthi HC, Bingham TA. Charles B. Drew University of Medicine and Sciences, University of California, Los Angeles.
Disproportionately high HIV/AIDS rates and frequent non-gay identification (NGI) among African American men who have sex with men or with both men and women (MSM/W) highlight the importance of understanding how HIV-positive African American MSM/W perceive safer sex, experience living with HIV, and decide to disclose their HIV status. Thirty predominately seropositive and non-gay identifying African American MSM/W in Los Angeles participated in three semi-structured focus group interviews, and a constant comparison method was used to analyze responses regarding condom use, sexual activity after an HIV diagnosis, and HIV serostatus disclosure. Condom use themes included its protective role against disease and pregnancy, acceptability concerns pertaining to aesthetic factors and effectiveness, and situational influences such as exchange sex, substance use, and suspicions from female partners. Themes regarding the impact of HIV on sexual activity included rejection, decreased partner seeking, and isolation. Serostatus disclosure themes included disclosure to selective partners and personal responsibility. Comprehensive HIV risk-reduction strategies that build social support networks, condom self-efficacy, communication skills, and a sense of collective responsibility among NGI African American MSM/W while addressing HIV stigma in the African American community as a whole are suggested. J Urban Health. 2006 Jul;83(4): 682-94.
Same race and older partner selection may explain higher HIV prevalence among black men who have sex with men
By Berry M, Raymond HF, McFarland W.
In a community-based survey in San Francisco, black men who have sex with men (MSM) had higher rates of same-race/ethnicity sexual partnerships and partners 10 or more years older compared with other MSM. Differences in sexual networks may explain why black MSM have higher HIV prevalence than other MSM despite lower levels of risk behavior. AIDS. 2007 Nov 12;21(17):2349-50.
The Extent of Bisexual Behaviour in HIV Infected Men and Implications for Transmission to Their Female Sex Partners
By J. P. Montgomery, E. D. Mokotoff, A. C. Gentry and J. M. Blair
Heterosexual transmission of HIV is a growing problem for women, but many women do not know how their partners acquired HIV. We described a group of HIV-infected men and women, and focused on: (1) sexual identity and bisexual behaviour in men, and (2) the proportion of women who acknowledged having a bisexual male partner. AIDS CARE (December 2003), VOL. 15, NO. 6, pp. 829_/837
Black Men Who Have Sex With Men and the HIV Epidemic: Next Steps for Public Health
By David J. Malebranche, MD, MPH
Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS in the United States. The Young Men’s Survey estimates an HIV incidence rate of 14.7% among BMSM in 6 US cities, compared with 2.5% and 3.5% among White and Hispanic men who have sex with men (MSM), respectively. Yet the disparity is not explained by higher rates of unprotected anal and oral sex. Am J Public Health. 2003 June; 93(6): 862–865.
Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors.
By Millett GA, Flores SA, Peterson JL, Bakeman R.
To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States. METHODS: A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies. AIDS. 2007 Oct 1;21(15):2083-91.
Minority Stress and Sexual Problems Among African-American Gay and Bisexual Men
By Zamboni BD and Crawford I.
Minority stress, such as racism and gay bashing, may be associated with sexual problems, but this notion has not been examined in the literature. African-American gay/bisexual men face a unique challenge in managing a double minority status, putting them at high risk for stress and sexual problems. Arch Sex Behav. 2006 Nov 16 pp 569-578
Differences in Disclosure of Sexuality Among African American and White gay/Bisexual Men: Implications for HIV/AIDS Prevention
By Kennamer JD, Honnold J, Bradford J, Hendricks M.
Gay and bisexual men were asked if they had disclosed their sexuality to family members, heterosexual friends, gay friends, coworkers, health care workers, and members of their church; if they had been associated with groups made up of gays, bisexuals, and lesbians; and if they had gay/bisexual friends. White men were much more likely to disclose their sexuality, to have associated with groups and to have gay/bisexual friends. AIDS Educ Prev 2000 Dec. 12 (6):519-31
Disclosure Decisions of Rural African American Men Living With HIV Disease
By Gaskins SW, Capstone College of Nursing, University of Alabama, AL
A qualitative study was conducted to explore disclosure decisions of rural African American men living with HIV disease. The sample consisted of 20 HIV-infected African American men living in the rural South who had been diagnosed with HIV for at least 6 months. Audiotaped semistructured interviews were used for data determination. The men were questioned about who they had told about their disease, reactions to their disclosures, and their advice to others about disclosing. Results showed that initially the men did not disclose their disease to others, and many of them continued not to disclose. J Assoc Nurses AIDS Care. 2006 Nov-Dec; 17(6):38-46
The Influence of Dual-identity Development on the Psychosocial Functioning of African-American Gay and Bisexual Men.
By Crawford I, Allison KW, Zamboni BD, Soto T.
To examine the influence of racial-ethnic and sexual identity development on the psychosocial functioning of African-American gay and bisexual men (AAGBM), 174 AAGBM completed questionnaire packets designed to assess their levels of racial-ethnic and sexual identity development, self-esteem, social support, male gender role stress, HIV prevention self-efficacy, psychological distress, and life satisfaction. J Sex Res 2002 May; 39(2):179-89
Greater Risk for HIV Infection of Black Men Who Have Sex With Men: A Critical Literature Review
By Greg Millett, Gregorio A. Millett, MPH, John L. Peterson, PhD, Richard J. Wolitski, PhD, and Ron Stall, PhD, MPH
HIV rates are disproportionately higher for Black men who have sex with men (MSM) than for other MSM. We reviewed the literature to examine 12 hypotheses that might explain this disparity. American Journal of Public Health June 2006, Vol 96, No. 6.
Masculine Socialization and Sexual Risk Behaviors Among Black Men Who Have Sex with Men
By David J. Malebranche, Emory University, Atlanta, Ga.; Errol L. Fields, Johns Hopkins University, Baltimore, Md.; Lawrence O. Bryant, Morehouse School of Medicine, Atlanta, Georgia; and Shaun R. Harper, University of Pennsylvania, PA.
Aspects of masculine socialization among Black men who have sex with men (MSM) and potential corresponding influences on high-risk sexual behaviors are explored in this study.
Race and Sexual Identity: Perceptions about Medical Culture and Healthcare among Black Men Who Have Sex with Men.
By Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW.
Black men who have sex with men (BMSM) in the United States are disproportionately affected by HIV. Using a qualitative approach, the authors describe the healthcare experiences of BMSM in New York State and Atlanta, GA, exploring the social issues that influence barriers to care, communication, and adherence in medical settings. J Natl Med Assoc. 2004 Jan; 96 (1):97-107.
Self-Identification as “Down Low” among Men Who Have Sex with Men (MSM) from 12 US Cities
By Wolitski RJ, Jones KT, Wasserman JL, Smith JC.
Men who have sex with men (MSM) who are on the “down low” (DL) have been the subject of considerable media attention, but few data on this population exist. This exploratory study (N=455) compared MSM who considered themselves to be on the DL with MSM who did not (non-DL MSM). 20% self-identified as DL. Blacks and Hispanics were more likely than Whites to self identify as DL. AIDS Behav. 2006 May 12
Sexual Risk in the Context of Same-Sex Behavior Grant Title: HIV Risk and Prevention Among At-Risk Men Who Have Sex with Both Men and Women (MSMW)
Principal Investigator: Brian Dodge, Ph.D.; Mentor: Theo Sandfort, Ph.D. Co-Investigators: Miguel Muñoz-Laboy, Dr.P.H.; Linwood Lewis, Ph.D.
In much previous HIV/AIDS research, men who have sex with both men and women (MSMW) and men who have sex exclusively with men (MSM) have been combined under the rubric of “MSM” without being examined separately in terms of their risk and prevention needs. However, a body of literature has also emerged that compares MSMW with MSM and explicitly identifies bisexual behavior and identity as significant psychosocial risk factors for HIV infection, particularly for African-American men and other men of African descent. The primary goal of this pilot study is to elicit qualitative data on individual, sexual, and social factors associated with HIV risk among at-risk MSMW. HIV Center for Clinical and Behavioral Studies.
Research in Progress
Social/Sexual Networks & HIV Risk: Men of Color
http://www.caps.ucsf.edu/research/portfolio/2008/Choi-MSMNetworks.pdf
Kyung-Hee Choi, George Ayala, Jay Paul, Steven Gregorich, and Trista Bingham
This study will advance theoretical understandings of HIV risk behaviors by examining potential mechanisms (i.e., social networks and sexual partnerships) through which social discrimination impacts sexual risk among MSM of color and offer valuable insights for possible interventions involving both individual and structural changes. In three phases, we will describe sexual partnership patterns and explain the association between social discrimination, social networks, sexual partnerships and HIV risk among African American, Asian and Pacific Islander (API), and Latino men who have sex with men (MSM) in Los Angeles, CA.
From July 2005 to July 2006, we conducted 6 focus group discussions and 35 in-depth interviews with 29 African American, 28 API, and 28 Latino MSM (aged 18+) in Los Angeles. African American, API, and Latino respondents all reported experiencing racism in Los Angeles from the mainstream gay community, sex partners, and society in general (on the street, at work and from police). Respondents expressed concern about negative race-based stereotyping of ethnic minorities by society in general (e.g., African Americans are inarticulate, Latinos are uneducated, APIs are subservient). API MSM reported feeling least sexually desirable and assumed to be sexually passive; African American MSM reported being called names on the street, seen as physically threatening, and assumed to be a criminal; and Latino MSM reported being ethnically and economically homogenized, assumed to all be Mexican gardeners or janitors. African American respondents had the most to say about institutional forms of racism (police harassment and discrimination in the work place) than their counterparts. (Excerpted from a presentation at the 2007 National HIV Prevention Conference, Atlanta, GA, December 2007)
Intervention for African American MSM Who Do Not Identify as Gay
http://www.caps.ucsf.edu/research/portfolio/2007/Prev7.pdf
Susan Kegeles, Carla Dillard Smith, Don Operario, Emily Arnold, and Michael Benjamin
Creating effective HIV prevention interventions for African American men who have sex with men (MSM) is among the most urgent priorities for the public health community. Among those at highest risk for HIV are African American MSM who identify as heterosexual. This is a community collaborative research study to identify factors related to HIV-related risk behavior for this group of men, and to develop an intervention specifically for African American MSM who identify as heterosexual. Through formative research (focus groups and individual interviews) and input from members of this group and community gatekeepers, this project will develop a culturally and gender-appropriate intervention tailored to the needs of these men.
Five lessons were learned from the formative research: (1) Intervention processes must respect men’s heterosexual identity. The intervention content should reflect men’s personal identities as heterosexual men; (2) Het-MSM often disassociate same-sex sexual behavior from personal/emotional significance. Sex with other men was commonly experienced in terms of discrete behavioral episodes lacking personal significance outside of the compartmentalized episodes themselves; (3) Spontaneous and unplanned sexual encounters with men are common, frequently occur in high-risk contexts such as parks, street locations, cars, and adult bookstores, and are often associated with substance use or monetary exchange. Men reported feeling unable to plan strategies for protecting themselves given the context of the sexual activities; (4) Dynamics with female and male partners are typically conflicted. Participants described ambivalent and tense dynamics with both their female and male partners. Issues of distrust, gendered stereotypes, and power dynamics appeared as frequent barriers to open communication about sexual risk and safer sex communications with female partners; (5) Cultural norms of masculinity underlie sexual tension and partner dynamics. Gender norms related to masculinity, family expectations, and the Church/spirituality pose significant challenges for the men in acknowledging and addressing the potential risks associated with their same-sex behavior. These findings provided insight into participant recruitment strategies, and clarified content areas to address through individualized counseling, including condom negotiation skills, relationship dynamics with female partners, spontaneous sex with male partners, and needs for sexual secrecy. Preliminary findings from the pilot intervention support the feasibility of recruiting, engaging, and retaining Het-MSM in this research project, and highlight a need for consistent and supportive staff training in providing HIV prevention counseling services to this group. A rigorous test of the efficacy of the Bruthas Project in causing behavior change among AA Het-MSM should be conducted.
A Randomized Controlled Trial of the Bruthas Project
Project Staff: Emily Arnold (Academic PI); Carla Dillard Smith (Community Co-PI); Susan Kegeles (Co-PI); Don Operario (Consultant); Michael Benjamin (Project Director)
Project Description: This is a follow up study to rigorously test the effectiveness of the Bruthas Project. Creating effective HIV interventions for African American men is among the most urgent priorities for the public health community. Among those at highest risk for HIV are African American men who have sex with men and women (MSMW) who do not identify as gay, and are sometimes referred to as “men on the down low (DL)” or “DL men.” This study is a randomized controlled trial of the Bruthas Program, an enhanced HIV counseling intervention, which involves HIV counseling and testing (HIV-CT) plus a series of individual sexual health promotion counseling sessions. We will compare the Bruthas Program to a standard program involving HIV counseling, testing and referral to general case management services. The enhanced counseling intervention sessions will address: (a) increasing comfort with one’s personal identity, (b) establishing positive relationships, and (c) building safer sex skills. A sample of 400 African American MSMW who do not identify as gay will be recruited from the San Francisco Bay Area. After receiving HIV counseling and testing, half will be randomly assigned to the enhanced intervention condition and half randomly assigned to the standard program. All participants will complete baseline, post-intervention, and 3-month post intervention behavioral risk assessments using an audio computer-assisted interview. A subset of participants will also complete post-intervention qualitative interviews to provide in-depth experiential insight into the intervention process. We will evaluate the effectiveness of the enhanced counseling intervention by evaluating our primary outcome, which is the reduction of sexual risk behavior among men participating in the enhanced intervention compared to men in a standard HIV-CT program. This work is a collaboration between the Center for AIDS Prevention Studies (University of California, San Francisco) and the California Prevention and Education Project (CAL-PEP) in Oakland, CA. Our team works out of a shared understanding that service providers, researchers, and community members must collaboratively work together to create solutions that can mitigate the spread of HIV/AIDS in the African American community.Brian Dodge, William L. Jeffries, Theo G. M. Sandfort.
Archives of Sexual Behavior | Volume: 37 | Issue: 5 | Pps: 683-696
http://www.springerlink.com/content/n672233371101622/
Little information is available about sexual risk, protective, and disclosure practices among Black bisexually active men and how these may be amenable to intervention when necessary. In-depth interviews were conducted with 30 at-risk urban Black men who have sex with both men and women (MSMW). Participants reported protecting themselves and their partners through routine HIV testing, using condoms consistently, engaging in strategic positioning during sexual activity, and limiting the number of sexual partners. In addition, they described several reasons for not using protection, including not having condoms available, enjoying sexual activity more without condoms, and perceiving female partners to be “safer” than male partners. Disclosure of bisexuality was complex and reportedly difficult, in particular to female and gay-identified male partners. Future interventions must not only build protection and disclosure skills among MSMW, but also increase broader social awareness and acceptance of male bisexuality.
Sexual Behavior, Sexual Identity, And Substance Abuse Among Low-Income Bisexual And Non-Gay-Identifying African American Men Who Have Sex With Men.
Arch Sex Behav. 2008 Jun 11. [Epub ahead of print]
Harawa NT, Williams JK, Ramamurthi HC, Manago C, Avina S, Jones M.
Department of Research, Charles R. Drew University, Los Angeles, USA, ninaharawa@cdrewu.edu
Researchers examined the role of drug use and addiction in same-sex sexuality among non-gay-identifying African American men who have sex with men or with both men and women (MSM/MSMW). Between July 2005 and February 2006, seven focus groups were conducted with 46 predominately low socioeconomic status African American MSM/MSMW. A total of 29 men self-identified as HIV-infected and 17 self-identified as uninfected. Alcohol, crack cocaine, and crystal methamphetamine were the primary drugs mentioned by participants. Drug use was identified as playing a central role in same-sex sexuality for many African American MSM/MSMW. Participants described alcohol use and drug transactions, use, and addiction as motivating sex with men, allowing and rationalizing same-sex activity and unprotected sex, and facilitating access to male sex partners. Some of those in treatment for substance abuse indicated that a readiness to admit their same-sex activity and come to terms with their homosexuality/bisexuality was necessary for recovery. Because successful engagement of non-gay-identifying African American MSM/MSMW is essential to the reduction of HIV transmission and substance abuse in Black communities, findings call for drug treatment approaches that acknowledge and accept diverse sexuality in clients.
Qualitative Findings from Men of African American Legacy Empowering Self (MAALES) Project: Sex, Sexual Identity and Substance Abuse among African American Men who have Sex with Men
John K. Williams, MD
Department of Psychiatry & Biobehavioral Sciences, UCLA
September 22, 2008
http://www.uclaisap.org/slides/presentations-psattc-sarc-2008-2007.html
Illicit drug use among MSM is an important HIV risk factor. Prevalence rates of substance use at MSM circuit parties were significantly related to high-risk use of ecstasy and ketamine. African Americans have reported slightly higher rates of substance use, and more frequent and more sever consequences, including poorer physical health outcomes and more sever social problems. African American MSMs reported specifically using marijuana and non-injected crack cocaine more frequently than MSMs of other ethnicities. Understanding the psychosocial and cultural issues influencing drug use and sexual behavior and identity among African American MSMs is essential to HIV risk reduction. A better understanding of sexual identity among African American men within a sociocultural and developmental framework is needed.
Research needed to more effectively combat HIV among African-American men who have sex with men.
Bing EG, Bingham T, Millett GA.
Drew CARES & Institute for Community Health Research, Charles Drew University of Medicine and Science, Los Angeles, CA 90059, USA. eric.g.bing@gmail.com
J Natl Med Assoc. 2008 Jan;100(1):52-6.
http://www.ncbi.nlm.nih.gov/pubmed/18277808?ordinalpos=9&itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_DiscoveryPanel.Pubmed_ Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed
It is estimated that nearly half of all African-American men who have sex with men (AAMSM) living in major U.S. cities are already infected with HIV. Without a substantial and committed investment in research in HIV prevention among AAMSM and subsequent evidence-based policies and community programs, it is unlikely that we will ever be able to curtail the HIV epidemic among African Americans in general, regardless of gender, age or sexual orientation. In this paper, we briefly review what is known and what research questions remain in order to curtail the epidemic among AAMSM. Finally, we provide recommendations for future research that include the: 1) development of a national cohort of young AAMSM to prospectively study biological, behavioral, social and contextual factors that place AAMSM at risk for infection with HIV and other STDs; 2) adapting existing interventions in HIV prevention to the unique characteristics of AAMSM and evaluating their effectiveness; 3) evaluating factors such as intracommunity and familial discrimination against AAMSM that may lead to lack of disclosure; and 4) enhancing our understanding of how cultural and social factors can be used in a positive and self-affirming way to strengthen HIV prevention and care for AAMSM.
PMID: 18277808 [PubMed - indexed for MEDLINE]
Circumcision Status and HIV Infection Among Black and Latino Men Who Have Sex With Men in 3 US Cities.
By Millett GA, Ding H, Lauby J, et al
To examine characteristics of circumcised and uncircumcised Latino and black men who have sex with men (MSM) in the United States and assess the association between circumcision and HIV infection. Using respondent-driven sampling, 1154 black MSM and 1091 Latino MSM were recruited from New York City, Philadelphia, and Los Angeles. J Acquir Immune Defic Syndr. 2007 Dec 15;46(5):643-650.
Love, Sex, and Masculinity in Sociocultural Context -- HIV Concerns and Condom Use among African American Men in Heterosexual Relationships
By Lisa Bowleg, University of Rhode Island
African American men in heterosexual relationships are virtually invisible in the theoretical and empirical psychological HIV/AIDS literature. This article posits that two theoretical frameworks—masculinity ideologies (MI) and sociocultural context—are important for comprehending Black men’s condom use.
The Influence of Dual-Identity Development on the Psychosocial Functioning of African-American Gay and Bisexual Men
By Isiaah Crawford, Loyola University of Chicago; Kevin W. Allison, Virginia Commonwealth University; Brian D. Zamboni, Loyola University of Chicago; and Tomas Soto, the CORE Center, Chicago, Ill.
To examine the influence of racial-ethnic and sexual identity development on the psychosocial functioning of African-American gay and bisexual men (AAGBM). Men and Masculinities. October 2004 pages 166-186
Roundtable: Male Circumcision and HIV Prevention: Is There Really Enough of the Right Kind of Evidence?
By Gary W Dowsett and Murray Couch
The discourse on HIV prevention at the XVI International Conference on AIDS in Toronto in August 2006 focused on the recently coined notion of “prevention technologies” which, while not including behaviour change, does include cervical barriers, pre-exposure prophylaxis with antiretroviral drugs, herpes suppression, microbicides, HIV vaccines, and as a newcomer to the list and, lauded as having most immediate promise, male circumcision. Deploying a very masculinist metaphor, male circumcision was often hailed at the Toronto conference as the newest “weapon in the arsenal.” Such a narrowly conceived range of biomedical prevention strategies, and their rendition as “technologies,” resonates with discourses now dominating the international HIV/AIDS field that favour medical intervention and morally sanctioned control over community mobilisation and activism for establishing and sustaining changes in behaviour. Reproductive Health Matters May 2007 (Vol. 15, Issue 29, Pages 33-44)
Higher Prevalence Of Childhood Sexual Abuse Among Latino Men Who Have Sex With Men Than Non-Latino Men Who Have Sex With Men: Data From the Urban Men’s Health Study
By Sonya Grant Arreola, Torsten B. Neilands, Lance M. Pollack, Jay P. Paul and Joseph A. Catania
The prevalence of childhood sexual abuse among Latino adult men who have sex with men who live in the US was estimated because a history of childhood sexual abuse increases HIV sexual risk behaviors and other negative health outcomes in adulthood. The Urban Men’s Health Study is a random-digit telephone probability survey of 2881 adult men who have sex with men (MSM) aged 18 years or older residing in San Francisco, New York, Los Angeles, and Chicago. Self-reported history of childhood sexual abuse was the main outcome measure gathered from 2692 MSM. Childhood Abuse and Neglect Received 31 March 2003; received in revised form 25 August 2004; accepted 9 September 2004.
Our lives: An examination of sexual health issues using photovoice by non-gay identified African American men who have sex with men.
By Mamary E, McCright J, Roe K. Department of Health Science, San José State University, California
African American men who have sex with men and who do not identify as gay are at high risk for HIV infection. This paper presents the results of the photovoice component, a participatory action research method, of a two-tiered qualitative study design that explored the perceptions of non-gay identified African American men who have sex with men living or working in the San Francisco Bay Area regarding the social, cultural, community, and family influences associated with their HIV risk and their general sexual health. Cult Health Sex. 2007 Jul-Aug; 9 (4):359-70.
Perceptions Towards Condom Use, Sexuality Activity, and HIV Disclosure Among HIV-Positive African American Men Who Have Sex with Men; Implications for Heterosexual Transmission
By Harawa NT, Williams JK, Ramamurthi HC, Bingham TA. Charles B. Drew University of Medicine and Sciences, University of California, Los Angeles.
Disproportionately high HIV/AIDS rates and frequent non-gay identification (NGI) among African American men who have sex with men or with both men and women (MSM/W) highlight the importance of understanding how HIV-positive African American MSM/W perceive safer sex, experience living with HIV, and decide to disclose their HIV status. Thirty predominately seropositive and non-gay identifying African American MSM/W in Los Angeles participated in three semi-structured focus group interviews, and a constant comparison method was used to analyze responses regarding condom use, sexual activity after an HIV diagnosis, and HIV serostatus disclosure. Condom use themes included its protective role against disease and pregnancy, acceptability concerns pertaining to aesthetic factors and effectiveness, and situational influences such as exchange sex, substance use, and suspicions from female partners. Themes regarding the impact of HIV on sexual activity included rejection, decreased partner seeking, and isolation. Serostatus disclosure themes included disclosure to selective partners and personal responsibility. Comprehensive HIV risk-reduction strategies that build social support networks, condom self-efficacy, communication skills, and a sense of collective responsibility among NGI African American MSM/W while addressing HIV stigma in the African American community as a whole are suggested. J Urban Health. 2006 Jul;83(4): 682-94.
Same race and older partner selection may explain higher HIV prevalence among black men who have sex with men
By Berry M, Raymond HF, McFarland W.
In a community-based survey in San Francisco, black men who have sex with men (MSM) had higher rates of same-race/ethnicity sexual partnerships and partners 10 or more years older compared with other MSM. Differences in sexual networks may explain why black MSM have higher HIV prevalence than other MSM despite lower levels of risk behavior. AIDS. 2007 Nov 12;21(17):2349-50.
The Extent of Bisexual Behaviour in HIV Infected Men and Implications for Transmission to Their Female Sex Partners
By J. P. Montgomery, E. D. Mokotoff, A. C. Gentry and J. M. Blair
Heterosexual transmission of HIV is a growing problem for women, but many women do not know how their partners acquired HIV. We described a group of HIV-infected men and women, and focused on: (1) sexual identity and bisexual behaviour in men, and (2) the proportion of women who acknowledged having a bisexual male partner. AIDS CARE (December 2003), VOL. 15, NO. 6, pp. 829_/837
Black Men Who Have Sex With Men and the HIV Epidemic: Next Steps for Public Health
By David J. Malebranche, MD, MPH
Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS in the United States. The Young Men’s Survey estimates an HIV incidence rate of 14.7% among BMSM in 6 US cities, compared with 2.5% and 3.5% among White and Hispanic men who have sex with men (MSM), respectively. Yet the disparity is not explained by higher rates of unprotected anal and oral sex. Am J Public Health. 2003 June; 93(6): 862–865.
Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors.
By Millett GA, Flores SA, Peterson JL, Bakeman R.
To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States. METHODS: A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies. AIDS. 2007 Oct 1;21(15):2083-91.
Minority Stress and Sexual Problems Among African-American Gay and Bisexual Men
By Zamboni BD and Crawford I.
Minority stress, such as racism and gay bashing, may be associated with sexual problems, but this notion has not been examined in the literature. African-American gay/bisexual men face a unique challenge in managing a double minority status, putting them at high risk for stress and sexual problems. Arch Sex Behav. 2006 Nov 16 pp 569-578
Differences in Disclosure of Sexuality Among African American and White gay/Bisexual Men: Implications for HIV/AIDS Prevention
By Kennamer JD, Honnold J, Bradford J, Hendricks M.
Gay and bisexual men were asked if they had disclosed their sexuality to family members, heterosexual friends, gay friends, coworkers, health care workers, and members of their church; if they had been associated with groups made up of gays, bisexuals, and lesbians; and if they had gay/bisexual friends. White men were much more likely to disclose their sexuality, to have associated with groups and to have gay/bisexual friends. AIDS Educ Prev 2000 Dec. 12 (6):519-31
Disclosure Decisions of Rural African American Men Living With HIV Disease
By Gaskins SW, Capstone College of Nursing, University of Alabama, AL
A qualitative study was conducted to explore disclosure decisions of rural African American men living with HIV disease. The sample consisted of 20 HIV-infected African American men living in the rural South who had been diagnosed with HIV for at least 6 months. Audiotaped semistructured interviews were used for data determination. The men were questioned about who they had told about their disease, reactions to their disclosures, and their advice to others about disclosing. Results showed that initially the men did not disclose their disease to others, and many of them continued not to disclose. J Assoc Nurses AIDS Care. 2006 Nov-Dec; 17(6):38-46
The Influence of Dual-identity Development on the Psychosocial Functioning of African-American Gay and Bisexual Men.
By Crawford I, Allison KW, Zamboni BD, Soto T.
To examine the influence of racial-ethnic and sexual identity development on the psychosocial functioning of African-American gay and bisexual men (AAGBM), 174 AAGBM completed questionnaire packets designed to assess their levels of racial-ethnic and sexual identity development, self-esteem, social support, male gender role stress, HIV prevention self-efficacy, psychological distress, and life satisfaction. J Sex Res 2002 May; 39(2):179-89
Greater Risk for HIV Infection of Black Men Who Have Sex With Men: A Critical Literature Review
By Greg Millett, Gregorio A. Millett, MPH, John L. Peterson, PhD, Richard J. Wolitski, PhD, and Ron Stall, PhD, MPH
HIV rates are disproportionately higher for Black men who have sex with men (MSM) than for other MSM. We reviewed the literature to examine 12 hypotheses that might explain this disparity. American Journal of Public Health June 2006, Vol 96, No. 6.
Masculine Socialization and Sexual Risk Behaviors Among Black Men Who Have Sex with Men
By David J. Malebranche, Emory University, Atlanta, Ga.; Errol L. Fields, Johns Hopkins University, Baltimore, Md.; Lawrence O. Bryant, Morehouse School of Medicine, Atlanta, Georgia; and Shaun R. Harper, University of Pennsylvania, PA.
Aspects of masculine socialization among Black men who have sex with men (MSM) and potential corresponding influences on high-risk sexual behaviors are explored in this study.
Race and Sexual Identity: Perceptions about Medical Culture and Healthcare among Black Men Who Have Sex with Men.
By Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW.
Black men who have sex with men (BMSM) in the United States are disproportionately affected by HIV. Using a qualitative approach, the authors describe the healthcare experiences of BMSM in New York State and Atlanta, GA, exploring the social issues that influence barriers to care, communication, and adherence in medical settings. J Natl Med Assoc. 2004 Jan; 96 (1):97-107.
Self-Identification as “Down Low” among Men Who Have Sex with Men (MSM) from 12 US Cities
By Wolitski RJ, Jones KT, Wasserman JL, Smith JC.
Men who have sex with men (MSM) who are on the “down low” (DL) have been the subject of considerable media attention, but few data on this population exist. This exploratory study (N=455) compared MSM who considered themselves to be on the DL with MSM who did not (non-DL MSM). 20% self-identified as DL. Blacks and Hispanics were more likely than Whites to self identify as DL. AIDS Behav. 2006 May 12
Sexual Risk in the Context of Same-Sex Behavior Grant Title: HIV Risk and Prevention Among At-Risk Men Who Have Sex with Both Men and Women (MSMW)
Principal Investigator: Brian Dodge, Ph.D.; Mentor: Theo Sandfort, Ph.D. Co-Investigators: Miguel Muñoz-Laboy, Dr.P.H.; Linwood Lewis, Ph.D.
In much previous HIV/AIDS research, men who have sex with both men and women (MSMW) and men who have sex exclusively with men (MSM) have been combined under the rubric of “MSM” without being examined separately in terms of their risk and prevention needs. However, a body of literature has also emerged that compares MSMW with MSM and explicitly identifies bisexual behavior and identity as significant psychosocial risk factors for HIV infection, particularly for African-American men and other men of African descent. The primary goal of this pilot study is to elicit qualitative data on individual, sexual, and social factors associated with HIV risk among at-risk MSMW. HIV Center for Clinical and Behavioral Studies.
Research in Progress
Social/Sexual Networks & HIV Risk: Men of Color
http://www.caps.ucsf.edu/research/portfolio/2008/Choi-MSMNetworks.pdf
Kyung-Hee Choi, George Ayala, Jay Paul, Steven Gregorich, and Trista Bingham
This study will advance theoretical understandings of HIV risk behaviors by examining potential mechanisms (i.e., social networks and sexual partnerships) through which social discrimination impacts sexual risk among MSM of color and offer valuable insights for possible interventions involving both individual and structural changes. In three phases, we will describe sexual partnership patterns and explain the association between social discrimination, social networks, sexual partnerships and HIV risk among African American, Asian and Pacific Islander (API), and Latino men who have sex with men (MSM) in Los Angeles, CA.
From July 2005 to July 2006, we conducted 6 focus group discussions and 35 in-depth interviews with 29 African American, 28 API, and 28 Latino MSM (aged 18+) in Los Angeles. African American, API, and Latino respondents all reported experiencing racism in Los Angeles from the mainstream gay community, sex partners, and society in general (on the street, at work and from police). Respondents expressed concern about negative race-based stereotyping of ethnic minorities by society in general (e.g., African Americans are inarticulate, Latinos are uneducated, APIs are subservient). API MSM reported feeling least sexually desirable and assumed to be sexually passive; African American MSM reported being called names on the street, seen as physically threatening, and assumed to be a criminal; and Latino MSM reported being ethnically and economically homogenized, assumed to all be Mexican gardeners or janitors. African American respondents had the most to say about institutional forms of racism (police harassment and discrimination in the work place) than their counterparts. (Excerpted from a presentation at the 2007 National HIV Prevention Conference, Atlanta, GA, December 2007)
Intervention for African American MSM Who Do Not Identify as Gay
http://www.caps.ucsf.edu/research/portfolio/2007/Prev7.pdf
Susan Kegeles, Carla Dillard Smith, Don Operario, Emily Arnold, and Michael Benjamin
Creating effective HIV prevention interventions for African American men who have sex with men (MSM) is among the most urgent priorities for the public health community. Among those at highest risk for HIV are African American MSM who identify as heterosexual. This is a community collaborative research study to identify factors related to HIV-related risk behavior for this group of men, and to develop an intervention specifically for African American MSM who identify as heterosexual. Through formative research (focus groups and individual interviews) and input from members of this group and community gatekeepers, this project will develop a culturally and gender-appropriate intervention tailored to the needs of these men.
Five lessons were learned from the formative research: (1) Intervention processes must respect men’s heterosexual identity. The intervention content should reflect men’s personal identities as heterosexual men; (2) Het-MSM often disassociate same-sex sexual behavior from personal/emotional significance. Sex with other men was commonly experienced in terms of discrete behavioral episodes lacking personal significance outside of the compartmentalized episodes themselves; (3) Spontaneous and unplanned sexual encounters with men are common, frequently occur in high-risk contexts such as parks, street locations, cars, and adult bookstores, and are often associated with substance use or monetary exchange. Men reported feeling unable to plan strategies for protecting themselves given the context of the sexual activities; (4) Dynamics with female and male partners are typically conflicted. Participants described ambivalent and tense dynamics with both their female and male partners. Issues of distrust, gendered stereotypes, and power dynamics appeared as frequent barriers to open communication about sexual risk and safer sex communications with female partners; (5) Cultural norms of masculinity underlie sexual tension and partner dynamics. Gender norms related to masculinity, family expectations, and the Church/spirituality pose significant challenges for the men in acknowledging and addressing the potential risks associated with their same-sex behavior. These findings provided insight into participant recruitment strategies, and clarified content areas to address through individualized counseling, including condom negotiation skills, relationship dynamics with female partners, spontaneous sex with male partners, and needs for sexual secrecy. Preliminary findings from the pilot intervention support the feasibility of recruiting, engaging, and retaining Het-MSM in this research project, and highlight a need for consistent and supportive staff training in providing HIV prevention counseling services to this group. A rigorous test of the efficacy of the Bruthas Project in causing behavior change among AA Het-MSM should be conducted.
A Randomized Controlled Trial of the Bruthas Project
Project Staff: Emily Arnold (Academic PI); Carla Dillard Smith (Community Co-PI); Susan Kegeles (Co-PI); Don Operario (Consultant); Michael Benjamin (Project Director)
Project Description: This is a follow up study to rigorously test the effectiveness of the Bruthas Project. Creating effective HIV interventions for African American men is among the most urgent priorities for the public health community. Among those at highest risk for HIV are African American men who have sex with men and women (MSMW) who do not identify as gay, and are sometimes referred to as “men on the down low (DL)” or “DL men.” This study is a randomized controlled trial of the Bruthas Program, an enhanced HIV counseling intervention, which involves HIV counseling and testing (HIV-CT) plus a series of individual sexual health promotion counseling sessions. We will compare the Bruthas Program to a standard program involving HIV counseling, testing and referral to general case management services. The enhanced counseling intervention sessions will address: (a) increasing comfort with one’s personal identity, (b) establishing positive relationships, and (c) building safer sex skills. A sample of 400 African American MSMW who do not identify as gay will be recruited from the San Francisco Bay Area. After receiving HIV counseling and testing, half will be randomly assigned to the enhanced intervention condition and half randomly assigned to the standard program. All participants will complete baseline, post-intervention, and 3-month post intervention behavioral risk assessments using an audio computer-assisted interview. A subset of participants will also complete post-intervention qualitative interviews to provide in-depth experiential insight into the intervention process. We will evaluate the effectiveness of the enhanced counseling intervention by evaluating our primary outcome, which is the reduction of sexual risk behavior among men participating in the enhanced intervention compared to men in a standard HIV-CT program. This work is a collaboration between the Center for AIDS Prevention Studies (University of California, San Francisco) and the California Prevention and Education Project (CAL-PEP) in Oakland, CA. Our team works out of a shared understanding that service providers, researchers, and community members must collaboratively work together to create solutions that can mitigate the spread of HIV/AIDS in the African American community.