Multilevel HIV Prevention Intervention for Young African American Men

Investigator: Susan Kegeles, PhD
Sponsor: NIH National Institute of Mental Health

Location(s): United States


HIV prevalence and incidence rates have reached catastrophic levels among young black men who have sex with men (YBMSM), ages 18-29. The goal of this project is to determine the efficacy of a multilevel, theory- based intervention, calld United Black Element (UBE), in reducing YBMSM's sexual risk behavior and increasing the frequency of HIV testing. Although based on the Mpowerment Project, a cost-effective HIV prevention intervention that has been shown to be efficacious in reducing the rate of unprotected sex among young MSM, UBE has been extensively adapted to the socioeconomic, cultural, and social context of YBMSM's lives. Through the development of an empowered, mobilized YBMSM community, UBE creates positive social norms around HIV prevention that are diffused throughout diverse social networks. We began work to launch and begin testing the efficacy of UBE in Dallas and Houston, TX with CDC funding; Dallas was randomized to the intervention condition. Large cities were chosen since that is where the majority of YBMSM reside, and testing a community mobilization approach in such a setting is critical in considering how to translate it to practice. It took longer than anticipated to fully implement UBE because of community capacity issues, but UBE is now fully implemented and is reaching into diverse social networks of Dallas YBMSM. The CDC funding that supported the intervention and baseline assessments has ended, and the Texas State Health Department is now funding UBE at a local organization with which we are collaborating. In the proposed mixed methods project, we have an extraordinary opportunity to study the impact of this intervention without having to start up or cover the costs of the intervention. Thus, the aims of this mixed methods project are to: 1) Analyze public health data and conduct 3 additional annual cross-sectional surveys of YBMSM in Dallas and Houston using venue-based sampling to determine the efficacy of UBE in: (a) reducing unprotected anal sex; (b) increasing recent HIV testing; (c) modifying psychosocial mediating variables that may be causally related to HIV risk reduction; and (d) changing psychosocial factors related to positive mental health and well-being; 2) Determine how community changes occur during implementation of UBE by examining when changes in the psychosocial mediating variables, sexual risk behavior and HIV testing take place and if changes in sexual risk behavior and testing continue to improve, remain the same, or decrease over time; 3) Explore how UBE penetrates diverse YBMSM subcommunities in Dallas, and how this multilevel intervention impacts individual, interpersonal, and social level factors related t risk behavior and testing. Using ethnography, we will follow a longitudinal cohort while the intervention is being fully implemented. 4) Examine the potential integration of biomedical HIV prevention methods into UBE through administering and analyzing quantitative data from the survey and qualitative data from the interviews.

Young black men who have sex with men (YBMSM) are contracting HIV at alarmingly high rates that far exceed other ethnic/racial groups and need an HIV prevention intervention that is culturally grounded, and helps them to reduce unsafe sex and increase the frequency of HIV testing. This intervention, United Black Element, creates an empowered, mobilized community of men who support each other about safer sex and testing and reaches all YBMSM throughout the community, whether they seek help to change their behavior or not. Community-level HIV prevention interventions such as this have been found in other studies to be very cost-effective, and thus is an excellent approach to pursue in terms of public health.