This application proposes to evaluate an already-created serial drama intervention, "Reality Check," on public buses in Los Angeles, CA. Young African Americans are very disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs). Social factors affecting their risk include poverty, poor access to preventive medical services, and homophobia, which causes some men who have sex with men (MSM) to be secretive about these activities and to be reluctant to be tested for HIV. Unfortunately, many of those infected with HIV are unaware of their infection and may be transmitting it, especially during the highly infectious acute infection stage. On the other hand, those who test positive reduce their risk-related behavior dramatically. Thus, the CDC has recommended universal HIV testing, but especially testing among those at highest risk. Accordingly, the broad, long-term objective of this application is to increase HIV testing among young African Americans. It proposes a pilot test of the effects of an innovative, theory-based HIV risk-reduction serial drama intervention, "Reality Check," among African Americans aged 14 to 24 years who ride public buses in impoverished African American neighborhoods in Los Angeles. "Reality Check" is a structural intervention in that it will be implemented in the natural environment of bus riders. It consists of 27 3-minute episodes. Each episode will be shown for 1 week on Tuesday, Thursday, Friday and Saturday, once each hour, on all public buses in Los Angeles, which are equipped with video screens. Previously shown episodes will be available on a YouTube link from Transit TV's website. The study will use a quasi-experimental control group design with pre- and multiple post-intervention assessments. Riders of public buses in impoverished African American neighborhoods in Richmond, CA, will serve as the control. Cross-sectional anonymous bus stop surveys of African American youth aged 14-24 who ride the bus through-and reside in--designated impoverished areas of both cities at least 3 times each week will be conducted before "Reality Check" is shown in Los Angeles, immediately after it is shown, and 3 and 6 months after it is shown. The study sample will include 200 youth who exit buses in each of the 2 cities at each of the 4 assessment points, for a total of 1,600 participants. Using a systematic sampling strategy based on the target population's times of highest ridership, data will be collected in private spaces near the bus stops from youth who exit the buses and recorded on hand-held mobile phones.
The Specific Aims i nclude conducting a pilot test of the effects of "Reality Check" in increasing HIV testing (the primary outcome), theoretical mediators of testing, condom use, and abstinence, and reducing homophobia and HIV/AIDS stigma, as compared with control. Effects on HIV testing rates in treatment versus control city also will be examined. This research would provide preliminary evidence of the effects of an intervention that could be disseminated very cost-effectively, with substantial reach via public buses in 4 additional cities where TEZO Systems Unlimited, Inc., the company that owns Transit TV, plans to broadcast.
Young African Americans are highly disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs). This study evaluates the effectiveness of a serial drama, delivered on local buses, at changing attitudes and/or behaviors among young African Americans. This research responds to the urgent public health need for structural interventions to reduce the risk of STIs, including HIV, in young African Americans.