Despite sharp increases in the incidence of HIV among young black men who have sex with men (MSM), most of these men, even low-income substance-using MSM who are at the highest risk for HIV, successfully avoid the virus. This suggests that men may be managing their sexual behaviors and substance use to achieve this, possibly in a systematic way, even though most fail 100% adherence to condoms and total abstinence from drugs. Although there are ample data on factors associated with risk for HIV, few studies have used a "positive deviance" approach (that is, a focus on adaptive strategies in high-risk individuals who successfully avoid a disease) to study adaptive strategies that facilitat avoidance of HIV. Objectives: The purpose of the proposed study is to discover a range of strategies for risk avoidance that have not been previously documented or measured, as well as symbiotic goals that might contribute to developing these strategies, and to develop a psychometrically sound scale with which to assess strategies. Our specific objectives are as follows: (1) Identify the range and nature of adaptive strategies used to avoid HIV as well as symbiotic goals that might contribute to maintaining and developing these strategies;(2) Develop items for an adaptive strategies scale;(3) Test the psychometric properties of the adaptive strategies scale. Assessing adaptive strategies and symbiotic goals for avoiding risks associated with HIV can contribute to realistic, effective strengths-based approaches to HIV prevention for young black drug-using MSM. We anticipate that the project will lead to a follow-up study to test the extent to which young black MSM use adaptive strategies and statistically confirm the relationships between engaging in these strategies and remaining HIV negative and to identify predictors of engagement in adaptive practices. Methods: During Phase 1 of our study, we will identify the nature and range of adaptive strategies through qualitative, in-depth semi-structured interviews with 30 young black, low-income, substance-using MSM recruited through convenience sampling. During phase 2, we will develop candidate items for an adaptive strategies scale using the most commonly discussed themes and concepts from the in-depth interviews. We will use theme analysis and pile-sorting techniques to identify common strategies and symbiotic goals. We will pre-test the validity of scale items through cognitive interviews with 5 MSM. Cognitive validation involves finding out what respondents are thinking when they answer the questionnaire items and how this cognition might affect responses. Finally, in Phase 3, we will field test the validity and reliability of the questionnaire among a sample of 100 low-income, substance-using black MSM between 18 and 30 who are HIV-negative. All prospective participants will be offered rapid HIV testing, pre- and post-test counseling, and referral to HIV treatment, and will be compensated $30 for participation.
Most behavioral interventions to date have failed to substantially lower HIV incidence among MSM. There is dire need for new approaches to HIV prevention in this group, particularly for MSM at the highest risk for HIV: young, black MSM who are low income and involved with substance use. We propose a new approach to prevention among young black MSM in which we (1) identify adaptive strategies and symbiotic life goals that may facilitate risk avoidance;and (2) develop and validate an adaptive strategies questionnaire. Relevance to public health is high in that a focus on adaptive strategies among those at the highest risk for HIV, but who have not contracted the disease, may direct development of effective sustainable strengths-based behavioral interventions.