Young black men who have sex with men (YBMSM) are contracting HIV at alarmingly high rates that far exceed other ethnic/racial groups. These disparities are not due to increased risk behavior among YBMSM, but seem to result because YBMSM who are sexually active are more likely to encounter infectious partners. YBMSM are more likely to be HIV+, and less likely to be on treatment for HIV, and to have undetectable HIV viral loads (VLs). When HIV+ men achieve an undetectable VL, their own health improves, and they are also less infectious to others. Getting to that point requires that HIV+ individuals go through a number of steps of engaging in the continuum of care (CC), such as obtaining health care for HIV, and taking medications as prescribed. The goal of this project is to develop, implement, and test a community-level intervention to build and mobilize communities of YBMSM (ages 18-29) to support HIV+ men about engaging in the CC. The intervention is called United Black Element+. The study is being conducted in Dallas and Houston, Texas.
HIV rates are at catastrophic levels among young black men who have sex with men (YBMSM). A study in 21 US cities found that 21% of YBMSM aged 18-29 were HIV+, compared to 9% of Latino and 7% of white young MSM (YMSM), and these disparities are worsening. YBMSM are more likely to be HIV-infected, less likely to be aware of their HIV-infection, and less likely to disclose that they are HIV-infected, relative to men of other ethnic/racial groups. HIV+ YBMSM are also less likely than white MSM to be in treatment for HIV and to have undetectable viral loads (VLs). When HIV+ individuals achieve an undetectable VL, their own health improves, and they are also less infectious to others. Getting to that point, however, requires that HIV+ individuals: (1) know their HIV status; (2) link to HIV care; (3) stay in care over time; (4) begin appropriate treatment; and (5) adhere to antiretroviral therapy (ART). We refer to these steps as engagement in the HIV Care Continuum (CC). While these approaches have great potential to reduce HIV incidence, it is estimated that only 25% of HIV+ people in the US have engaged in the CC to the point of having undetectable VLs. Research suggests that HIV+ YBMSM engage in the CC far less than others. A community-level intervention (CLI) to build and mobilize communities of YBMSM to support HIV+ men to engage in the CC, decrease psychosocial barriers and increase psychosocial facilitators to engage in the CC within those communities may be an efficacious approach to prevent HIV transmission and improve health outcomes for YBMSM. This proposal will test the efficacy of such a CLI model, called United Black Element+ (UBE+). UBE+ will be an adaptation of a current CLI, called UBE. UBE has already engaged hundreds of YBMSM in Dallas TX, and it diffuses support for HIV prevention and creates positive social norms around reducing rates of unprotected sex and increasing regular HIV testing by building an empowered, mobilized YBMSM community. UBE+ will be an adaptation and extension of UBE designed to increase YBMSM's engagement in the CC. The aims of this project are: (1) To adapt and expand UBE into UBE+, a multilevel intervention that includes a new focus on increasing engagement in the CC among HIV+YBMSM, including targeting psychosocial barriers and facilitators to engaging in the CC that are experienced in this community (e.g., HIV stigma and social support); (2) To implement UBE+ in Dallas for 3 years in collaboration with a local AIDS Service Organization currently implementing UBE, the Dallas County Health Department, and the Texas Department of State Health Services' (TDSHS) HIV-STD Program; and (3) To evaluate the efficacy of UBE+ in increasing engagement in the CC in Dallas (utilizing Houston as a control community) using 2 independent methods: (a) a longitudinal cohort of HIV+ YBMSM providing data on engagement in care, and experiences of psychosocial and logistic barriers and facilitators to engagement in care; and (b) public health data that the TDSHS independently collects on HIV+ YBMSM's engagement in the CC.