Sexual transmission is the predominant route of HIV infection in the United States, and it is men who are primarily spreading the virus. Male-to-male sexual contact accounts for 72% of all new HIV infections in men while heterosexual contact accounts for 83% of all new HIV infections in women. Extrapolating this incidence data reveals that 75% of all new HIV cases result from high risk sexual activity by men. These new infections are also not evenly distributed throughout the population. African Americans comprise only 14% of the US population, but account for 44% of the new infections. Black men, in particular, are disproportionately burdened, accounting for 70% of new HIV cases among African Americans. In addition, African Americans tend to have sex with people of the same race. As the prevalence of HIV increases within this community, the risk of infection concomitantly increases with each new sexual encounter. Given this epidemiological reality, reducing sexual risk behaviors among African American HIV+ men who have sex with men (MSM), with women (MSW), and with both men and women (MSM/W) is a prevention imperative. To address this, we intend to develop and test Positively tHrIVing, an HIV behavioral intervention based on modules 2 and 3 of the Healthy Living Project (HLP;a "best evidence" CDC intervention), and then tailored it to fit the unique needs of HIV+ African American men (both MSM and MSW). This will include a focus on the distinctive challenges faced by all men independent of race (e.g., the influence of gender roles on sexual risk behaviors), faced by African-Americans living in the United States (e.g., discrimination, socioeconomic issues), and the intersection of these factors with the gender of sexual partners (e.g., managing power inequalities in heterosexual relationships v. facing homophobia and cultural issues). Additionally, Positively tHrIVing will adopt a pro-health point of view so that it will be perceived as supportive and nonstigmatizing. Finally, Positively tHrIVing will be computer-based to further increase acceptability among patients and physicians, reduce staff time, lower costs, increase fidelity of treatment delivery, and enhance the probability of widespread dissemination. The results of Phase I strongly support the feasibility and potential effectiveness of the program - far exceeding the three usability benchmarks established in the Phase I proposal. In Phase II we will complete development of the Positively tHrIVing program and test its effectiveness in a pretest-posttest experimental design. 240 HIV+ African American men will be randomly assigned to receive either the computer-based Positively tHrIVing program or flash-enabled STD CDC fact sheets. Before, and at two points after random assignment, participants'sexual transmission risk behavior, medication adherence, disclosure, health behaviors, and substance use will be assessed through an online survey-questionnaire.
This project aims to develop a computer-based HIV behavioral intervention for HIV+ African American men. For clinics, this will allow them to provide an empirically validated HIV prevention intervention to their clients without creating additional demands on their already overburdened staff. For HIV+ African American men, the skills contained in this program will help them reduce risk behaviors and, ultimately, prevent the spread of HIV.