HIV Prevention Research: ACTIVE
PEPTALK
TRUST
SPECIFIC AIMS
Increasing HIV testing rates among young, Black men who have sex with men (YBMSM) is critical to reducing the disproportionate disease burden in the Black community. MSM comprised almost two-thirds of new HIV diagnoses in the United States (US) in 2010. Rates of new HIV infections increased 48% between 2006 and 2009 among YBMSM; a recent study reported a nearly 6% annual HIV incidence among YBMSM. A significant portion of YBMSM has not tested in the prior year and YBMSM are 7 times more likely to be unaware of their HIV infection, as compared to other young MSM.
We propose a study to design and test a brief intervention to increase uptake of consistent HIV self-testing among YBMSM using a novel and culturally-relevant “buddy system” approach. In our model, peer educators train pairs of YBMSM (or “buddies”) to initiate self-testing and support each other in consistent self-testing (every 3 months) and sexual and AOD use risk reduction. The self-test is a promising new method because it reduces the negative impact of several barriers to HIV testing, such as HIV testing stigma, homophobia, mistrust of medical care providers/system, limited access to HIV testing, and confidentiality and privacy concerns, all of which are significant barriers to HIV testing among YBMSM. Because self-testing is relatively complex, uptake may vary based on how a user is introduced to and supported in consistent use of the method and whether this is done in a culturally-relevant context. Concerns around reduced test sensitivity due to lack of operator training also exist. We propose to address these issues by introducing the self-test as a user-controlled and empowering method of sexual health maintenance and delivering a self-test skills-building, peer support and motivation-enhancing intervention. Based on social cognitive and peer support theories, the intervention is framed as an empowering method, which we hypothesize will increase uptake and maintenance of self-testing, both by building on the powerful social networks in the Black community that enhance resilience and by recognizing the historical and sociostructural oppression African Americans face.
This study builds on our experience managing a successful HIV testing program (“The Men’s Testing Initiative”) that has provided testing to over 600 MSM, 30% of whom were YBMSM, and designing and testing HIV prevention interventions with MSM and in the Black community. The intervention, which is brief, focused and tailored, has three primary components. First, buddies will receive a 25-minute self-testing skills-building, motivation-enhancing and peer support-focused session, rapid HIV testing and free self-test kits at our fixed site or on our mobile testing unit. Second, additional self-tests will be delivered (or accessed) as needed, using the delivery method of their choice. Third, booster messages, based on personalized testing plans developed during the initial session, will be delivered using preferred type of communication technology (e.g., texts, e-mail, calls). A peer educator will deliver the intervention; throughout, on-demand technical support will be available to buddies from the study team using the full range of communication technology.
The specific aims of this developmental R01 study are:
1. To conduct qualitative formative research to adapt couples testing for self-testing with a buddy;
2. To assess the preliminary efficacy of the intervention to increase the proportion of YBMSM who self-test regularly (i.e., every three months) over 12 months using a 2-arm randomized, controlled study design.
We will achieve the aims of the study in three phases, recruiting YBMSM using web- and app-based approaches. In Phase 1, we conducted 30 in-depth interviews to identify barriers to, facilitators of, perceptions of and preferences for regular HIV self-testing, describe how AOD use and sexual behavior influence HIV self-testing behaviors, and assess participant perspectives on the proposed buddy intervention. In Phase 2, based on the formative research, we adapted couples testing, integrating enhanced motivational interviewing techniques to create a brief, peer educator-delivered, face-to-face intervention. In Phase 3, we will use web- and app-based, face-to-face and word-of-mouth approaches to recruit 376 HIV-negative, BMSM aged 18 to 29 who will be randomized as pairs to either the intervention arm (HIV testing together, HIV self-testing screening information and skills training; free test kits on demand; tailored booster messages) or the control arm (HIV testing separately, generic health screening information; free test kits on demand) and followed for 12 months to estimate the intervention’s efficacy in increasing regular HIV self-testing according to self-report. If demonstrated to be efficacious, this innovative and efficient approach can be adapted easily for widespread distribution, with the potential to diffuse along naturally occurring, social networks among YBMSM.
HIV Prevention Research: PAST
CHHANGE “Challenge HIV Stigma and Homophobia and Gain Empowerment”
SPECIFIC AIMS
HIV/AIDS stigma and homophobia, based on sexuality, sexual orientation or sexual identity, are major community-level barriers to effective HIV treatment and prevention, reducing access to HIV testing, medical treatment, and uptake of novel biomedical HIV prevention technologies, such as pre/post-exposure HIV prophylaxis (PEP/PrEP), critical tools to interrupt HIV transmission and reduce community viral load in high risk populations and high HIV prevalence areas. HIV stigma and homophobia manifests in negative attitudes and beliefs at the community-level and is enacted by community members; stigma can also beinternalized by affected individuals. Compounded stigma, where HIV stigma is layered with heterosexism, racism and classism, acts as a particularly significant barrier to HIV prevention for African American gay, bisexual and other men who have sex with men (MSM) living in urban areas. Interventions to decrease HIV/AIDS stigma have focused on education and changing attitudes towards people living with HIV/AIDS (PLWHA), but few have been rigorously evaluated or have addressed the role of “gay space” in urban areas. Creating neighborhood “gay space” may decrease stigma and homophobia, by increasing visibility of and contact with lesbian, gay, bisexual, transgender and questioning (LGBTQ) people and PLWHA,offering a safer space for LGBTQ youth and PLWHA to seek and give social support, providing accurate information and education to the community, and increasing physical access to HIV prevention and testing services. However, space can also become stigmatized and be stigmatizing, reducing access to HIV prevention, treatment and testing. Approaches to overcome this include HIV testing in routine medical care settings, via mobile units, venue-based testing, and HIV home testing. To some extent these approaches work around HIV stigma, rather than address it. Further, not all approaches can and should be done at home, virtually, on a mobile unit or in a venue. And successful management of HIV often requires physical access to HIV care providers and other supports. Thus, there is a compelling need to reduce community-level stigma and homophobia to increase access to HIV prevention technologies, testing services and treatment.
Harnessing the power of community or neighborhood space to both reduce HIV stigma and homophobia and increase access to HIV prevention technologies is a promising strategy, particularly for LGBTQ youth (who often have no local gay space) and in communities with high HIV prevalence. Our preliminary qualitative research reveals that accessing gay space can mitigate the negative effects of homophobia and HIV stigma among young African American MSM. Our research also shows that significant proportions of adult MSM not living in gay enclaves report experiencing sexual orientation-based discrimination in their home neighborhoods. The New York City-based organization Gay Men of African Descent (GMAD), based in Brooklyn, has developed an anti-stigma program, providing education to the faith community, an intermittent, city-wide bus and subway ad campaign and other media strategies. The purpose of the proposed research is to conduct formative participatory research to develop and implement neighborhood space-based intervention components, added to the GMAD program and delivered intensely, to obtain a preliminary estimate of the efficacy of the anti-stigma and homophobia intervention. Thus the specific aims of the study are to:
1. Assess how community members and organizations conceptualize HIV stigma and discrimination in space using participatory research methods (e.g., strategy diagrams, strengths analyses, concept mapping groups);
2. Develop neighborhood space-based community-level intervention components added to existing anti-stigma approaches to decrease community-level HIV stigma and homophobia and knowledge of and perceived access to HIV testing and prevention technologies;
3. Test the preliminary efficacy of the enhanced intervention in reducing community-level HIV stigma and homophobia and increasing knowledge of and perceived access to HIV testing and prevention technologies.
To achieve these aims we have assembled a team including LGBT community leaders (GMAD and Brooklyn Men (K)onnect) with a strong record of community-based work, and HIV prevention scientists. In phase 1, we will conduct formative participatory research with community members and organizations focused on stigma, homophobia, neighborhood space and physical access to HIV testing and prevention. Based on these results, in phase 2, we will develop community-level intervention components. In phase 3, we will deliver and pilot test the full intervention using a quasi-experimental study design, conducting 400 cross sectional street intercept surveys in two high HIV-prevalence neighborhoods, matched for sociodemographics, population size, and “gay presence” (number of same-sex households) before and after the intervention (N=1600). Using linear change models with propensity score stratification to control for residual confounding between the intervention and control groups, we will assess changes in our outcomes, HIV/AIDS stigma and homophobia, as well as secondary outcomes in HIV knowledge and knowledge of and perceived access to HIV prevention services. Establishing preliminary efficacy of a community-level anti-stigma intervention addresses a major gap and is the first step to evaluating impact on access to HIV testing and prevention to reduce HIV infection and lower community viral load in high HIV prevalence areas and populations.
2. Develop neighborhood space-based community-level intervention components added to existing anti-stigma approaches to decrease community-level HIV stigma and homophobia and knowledge of and perceived access to HIV testing and prevention technologies;
3. Test the preliminary efficacy of the enhanced intervention in reducing community-level HIV stigma and homophobia and increasing knowledge of and perceived access to HIV testing and prevention technologies.
To achieve these aims we have assembled a team including LGBT community leaders (GMAD and Brooklyn Men (K)onnect) with a strong record of community-based work, and HIV prevention scientists. In phase 1, we will conduct formative participatory research with community members and organizations focused on stigma, homophobia, neighborhood space and physical access to HIV testing and prevention. Based on these results, in phase 2, we will develop community-level intervention components. In phase 3, we will deliver and pilot test the full intervention using a quasi-experimental study design, conducting 400 cross sectional street intercept surveys in two high HIV-prevalence neighborhoods, matched for sociodemographics, population size, and “gay presence” (number of same-sex households) before and after the intervention (N=1600). Using linear change models with propensity score stratification to control for residual confounding between the intervention and control groups, we will assess changes in our outcomes, HIV/AIDS stigma and homophobia, as well as secondary outcomes in HIV knowledge and knowledge of and perceived access to HIV prevention services. Establishing preliminary efficacy of a community-level anti-stigma intervention addresses a major gap and is the first step to evaluating impact on access to HIV testing and prevention to reduce HIV infection and lower community viral load in high HIV prevalence areas and populations.
Sexual Violence Prevention Research
Men’s Experiences of Sexual Violence
OBJECTIVES
The objective of the study is to understand experiences and conceptualizations of sexual violence among individuals who identify themselves as males, both cisgender (their gender identity conforms to their biological sex) and transgender (their gender identity does not conform to their biological sex) using mixed research methods. The project is sponsored by a grant from the New York City Council to The Crime Victims Treatment Center (CVTC) of St. Luke’s-Roosevelt Hospital and is designed to provide information that will help CVTC increase access to their services for male victims of violence.
SPECIFIC AIMS
The proposed study will use a mixed methods approach to explore how sexual violence is conceptualized among both cisgender and transgender men, approaching this from the perspective of sexual experiences, as opposed to violence experiences. The study will use both quantitative and qualitative research methods to develop a grounded understanding of what these individuals think and feel about these experiences, as well as the impacts that the experiences have had on them. Finally, the research will explore what sort of outreach to cisgender and transgender male survivors might increase the likelihood of their seeking services related to these experiences. Thus the specific aims of the study are to:
1) To describe the range of sexual experiences that are identified as experiences of “sexual violence using both quantitative and qualitative methods;
2) To characterize the social contexts and cognitive and affective processes that are related to categorizing a sexual experience as a “sexual violence experience;”
3) To explore what factors, with an emphasis on whether and how categorizing a sexual experience as a sexual violence experience, are associated with help-seeking and service receipt.
We will achieve these aims in three phases. In Phase 1, we will conduct a brief eligibility screener, to identify individuals who have experienced sexual violence and/or have sought services. In Phase 2, we will conduct twenty in-depth interviews, with cisgender and transgender males who have experienced recent sexual violence. In Phase 3, we will conduct two focus groups with the two sets of men.
