Recent HIV surveillance data show that men who have sex with men (MSM) are the only risk group in which the number of new infections rose annually from 2001-2006 (Hall et al., 2008). Among persons aged 13-24, Blacks are disproportionately affected by HIV infection accounting for 55% of all HIV infections reported (CDC, 2005). These racial disparities among MSM persist in the Chicago area, with the HIV prevalence rate among Black MSM (30.1%) more than twice that of White (11.3%) and Hispanic MSM (12.0%) (Chicago Department of Public Health, 2009). The racial disparity in HIV prevalence rate is even more striking among youth ages 18-24, with 24.2% among Black YMSM compared to 2.3% for White YMSM and 6.5% for Hispanic YMSM (CDPH, 2009). Despite the urgent need, there are no theoretically based, culturally appropriate behavioral interventions to reduce the risk of sexual acquisition or transmission of HIV among BYMSM. Furthermore, there are no HIV prevention interventions specifically targeting the House Ball community, an understudied and clandestine subculture of the Black gay community with high HIV prevalence (Sanchez et al., 2009;Marks et al., 2008;Murill et al., 2005). The d-up! Defend Yourself"""""""" intervention, which has shown efficacy with BMSM (Jones et al., 2008), may be particularly well-suited for reaching BYMSM in the House Ball community. An adaptation of Kelly's Popular Opinion leader (POL) intervention ((Kelly et al., 1991,1992,1997,2006;Fernandez et al., 2003, 2005), d-up! Defend Yourself! utilizes opinion leaders from within the community to change social norms and perceptions of BMSM regarding safer sex practices (Jones et al., 2008). d-up! is delivered by members of the targeted community, thus providing """"""""intravention"""""""", an approach most appropriate for insulated and marginalized communities such as the House Ball community (Bailey, 2009;Friedman et al., 2004). In this application, we propose to tailor the d-up! intervention for relevance with the Chicago House Ball community and then conduct a small, pilot trial to test for feasibility and acceptability. We will begin by conducting a series of focus groups in order to identify persuasive, culturally-appropriate messages and identify intervention targets. Based on focus group data, we will then tailor the intervention to be relevant for the Chicago House Ball community. We will then use Kelly and colleagues (2004) procedures for identifying popular opinion leaders from within the community and inviting them to participate in the study. We will implement a baseline community risk assessment by obtaining a convenience sample of approximately 150 youth attending the School of Opulence over three consecutive weeks. Then, opinion leaders will be trained on the tailored intervention over a period of four weeks. We will conduct four equally spaced (3, 6, 9, 12 months post-baseline) cross-sectional follow-up assessments of convenience samples of youth (i.e. approximately 150 youth at each time point) from the House Ball community. The follow-up assessments will include measures of sexual risk behavior in the past 3 months and exposure to the intervention through opinion leaders and marketing materials over the past 3 months. Opinion leaders will be asked to rate the acceptability of the intervention and the feasibility of communicating risk reduction messages within their social networks. Feasibility of the overall intervention will also be assessed by the number of opinion leaders recruited that agreed to be trained, the number of risk reduction conversations documented by opinion leaders, and retention of the opinion leaders over the project period.

Public Health Relevance

For this application, we will examine the feasibility and acceptability of a popular opinion leader intervention for use with Black, young men who have sex with men that participate in the House Ball community in Chicago.
The aim of such an intervention is to decrease HIV infections in a community already disproportionately impacted by HIV. This intervention has great potential to directly impact the lives of young men who have sex with men in the House Ball community and to decrease HIV transmission to sexual partners inside and outside of the community.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Special Emphasis Panel (ZMH1-ERB-E (09))
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Kamath, Susannah M Allison
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Hektoen Institute for Medical Research
United States
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