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National HIV Prevention Conference
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[TITLE:] ADAPTING AN EVIDENCE-BASED HIV PREVENTION INTERVENTION FOR YOUNG BLACK MSM
Natl HIV Prev Conf. 2005 Jun 12-15 (abstract no. M1-C1202)
Kegeles, SM1; Rebchook, G1; Bowen, C2; Mosby, R, Jr.3; Wilson, P4
1Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, CA; 2Minority AIDS Project, Unity Fellowship Church, Los Angeles, CA; 3Sexual Minority Alliance of Alameda County (SMAAC), Oakland, CA; 4Black AIDS Institute, Los Angeles, CA
BACKGROUND: Young Black MSM (YBMSM) are the group at highest risk for HIV in the US and research indicates a need for a community-level approach to reach them. No evidence-based interventions specifically for YBMSM have been developed. The Mpowerment Project (MP), a communitylevel, multi-component intervention for HIV-negative and HIV-positive men, has been found to be effective in reducing rates of unprotected anal sex among other young gay/bisexual men, but MP needs to be adapted to meet YBMSM's needs most effectively. Three African American communitybased organizations (CBOs) are partnering with the MP developers to adapt and pilot-test the adapted intervention.
METHODS: Two Boards of Cultural Experts (BOCEs) were convened, one each in Oakland/San Francisco and Los Angeles, and they were primarily comprised of older Black gay/same gender-loving (SGL) men (N=21) who had spent considerable time thinking about and working on issues affecting Black gay/SGL men. The BOCEs met 8 times to .deconstruct. MP regarding its appropriateness and utility for YBMSM. In addition, 6 focus groups of YBMSM in Oakland and LA (N=34) analyzed MP with respect to YBMSM. Themes that arose in the various groups were analyzed and implications for changes to MP were developed. BOCEs approved proposed adaptations.
RESULTS: The guiding principles (e.g., community-building, empowerment, peer outreach), structure (paid staff, volunteers, core group) and intervention components (small groups, publicity, formal outreach, informal outreach, community space) from MP continue to be relevant for YBMSM. However, many issues arose regarding the need for substantial adaptation of the intervention. A sampling of the issues is described here. Theme Meaning of theme Implications for MP changes Internalized Many YBMSM internalize homophobic Emphasize pride throughout the project.
| Theme | Meaning of theme | Implications for MP changes |
| Internalized oppression | Many YBMSM internalize homophobic and racist messages, resulting in poor regard for self and sex partners. | Emphasize pride throughout the project; the small group component needs to be adapted. |
| Whole man | Don’t only focus on sex, but recognize family, spirituality, community, history. | Address multiple facets of becoming a fully functioning man, such as job and life skills training, wellness. |
| Diverse sexual identities | YBMSM identify as gay, SGL, bisexual, straight. | Project should welcome men with diverse identities and be careful in use of gay imagery. |
| Lack of adult male role models | Many YBMSM have not had men in their lives, and have no vision of what an older Black gay/SGL man’s life is like. | Add a mentoring component and train mentors. |
| Discomfort with traditional pedagogy | Traditional ways of teaching is not successful, alienates men. | Use more culturally relevant and appropriate exercises (e.g., music, affirmations, spoken word). |
| Church/religiosity/ spirituality |
YBMSM feel alienated from and/or participate in church, and many need to reconcile same sex desire with Christianity. | Address religion in men’s lives, and via discussion groups, panels, speakers, help find options for spirituality. |
CONCLUSION: Risk behavior among YBMSM occurs in a very different cultural, economic, and social context from the original MP research communities. Re-designing MP requires new components and considerable reframing of current components. The adapted intervention is now being pilot-tested at the CBOs. Careful focus on adapting interventions for specific ethnic groups is critically important.
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050612
M1-C1202
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