(provided by the applicant): The high rates of sexually transmitted disease (STD), including HIV, among African American (AA) men who reside in urban areas are a major public health problem. In addition, the most common route of HIV transmission among AA women is heterosexual exposure. Yet, little research has focused on gender-specific strategies to dissuade heterosexually active AA men from engaging in high HIV/STD transmission risk behaviors. Accordingly, the broad, long-term objective of this research is to develop such strategies.
The Specific Aims i nclude testing the efficacy of a theory-based, gender-specific contextually appropriate HIV/STD risk-reduction intervention in increasing consistent condom use, identifying theoretical mediators that account for the intervention's effects, and testing a strategy to increase the longevity of the intervention's effects. This research will utilize a randomized controlled trial design with 360 inner-city AA men 18 to 45 years who report recent unprotected vaginal or anal intercourse with a woman. Men will be randomly allocated to one of two small-group interventions specially designed for AA men: (a) a HIV/STD risk-reduction intervention or (b) a health promotion control intervention on healthful diet and physical activity. To evaluate a strategy to increase the longevity of intervention effects, the men also will be randomized to receive or not receive individually tailored mailings to reinforce the intervention's message. The approach draws on social cognitive theory, the theory of planned behavior, and the applicant's Preliminary Studies with AA men. The primary outcome is self-reported consistent condom use during vaginal and heterosexual anal intercourse in the previous 3 months collected at baseline and 6 and 12 months post-intervention via audio-computer-assisted self-interviewing (ACASI). Secondary outcomes include other sexual behaviors and theoretical variables hypothesized to mediate intervention efficacy. Generalized estimating equations (GEE) and random effects models will be employed to address the Specific Aims.
This research may provide an urgently needed intervention to reduce the risk of STDs, including HIV, in African American men, one of the highest risk populations in the US. Moreover, African American women have 20 times the rate of HIV seen in White women, with over 75% of the cases are tied to sexual relations with men. However, few trials have tested gender-specific HIV/STD risk-reduction interventions for heterosexually active men.