HIV infection directly or indirectly related to male-to-male sexual intercourse is the single major contributor to HIV infection among African-Americans, accounting for an estimated 50% of all US AIDS cases diagnosed among African-American men. Despite this disproportionate burden, few HIV prevention/risk reduction interventions have been specifically designed and evaluated for efficacy among African American men who have sex with men (AAMSM). The proposed study will address this gap by implementing and rigorously testing the efficacy in reducing HIV risk behaviors among a sample of 300 AAMSM aged 18-55 in New York City of the Critical Thinking and Cultural Affirmation (CTCA) HIV risk behavior intervention. The CTCA strategy is a home-grown, African-American culturally-informed model which has been implemented for over a decade in Los Angeles, California, and since 2002, in New York City. Based in social cognitive behavioral theory, the CTCA intervention combines critical thinking, African- American cultural awareness, health literacy, counseling and group dynamics to empower AAMSM to reduce their HIV risk behaviors and move toward self-actualization and greater responsibility for themselves and their community. The proposed study will compare the CTCA intervention to standard HIV testing and counseling protocol (standard of care), hypothesizing: 1) that participants who complete the intervention will report greater reductions in sexual risk behaviors than the standard care comparison group;and 2) that the CTCA intervention is more cost effective than the standard of care. Consistent with established criteria for providing best-evidence of intervention efficacy, the study will be a pre-test/post- test design with randomized assignment to intervention and comparison groups;have a strategy to retain at least 70% of participants through study completion;collect data at baseline, immediately post- intervention, and at a minimum, at 3 and 6 months post-intervention;rigorously measure outcomes that directly impact AAMSM's HIV risk (e.g., number of sex partners, condom use) or a biologic measure indicating HIV or STD infection.
The Specific Aims of this study are 1) to further explicate and develop the homegrown CTCA intervention, 2) to evaluate its efficacy and cost-effectiveness in reducing AAMSM's HIV risk behaviors, and 3) thereby to expand the limited body of research on HIV prevention/risk reduction practices for AAMSM. Relevance: Given the shortage of tested and effective HIV prevention interventions for AAMSM and their disproportionate and rising HIV burden, the proposed study addresses a most urgent public health need. Advancing understanding of the risk behaviors, rates and incidence of HIV/AIDS among AAMSM, and creating effective risk interventions for them must be part of the agenda to reverse the worsening epidemic among African-Americans in the United States.
The Critical Thinking and Cultural Affirmation (CTCA) will be evaluated to assess its effectiveness to reduce sexual risk behaviors, (e.g. un-protected sex) among sexually-active African American MSM. This intervention will be compared to standard HIV testing and counseling services typically offered to men in New York City. The findings from this intervention will be relevant to public health, inasmuch as they will contribute to the much-needed prevention intervention resources for sexually-active African American MSM.