Nationally, rates of HIV among African American men who have sex with women (MSW) in both rural and urban areas are nearly 10 times as high as those reported for Caucasian MSW and have increased annually since 2004. This increase is particularly evident in small towns and rural communities in the South. The years following high school are a critical period when rural African American MSW are particularly vulnerable to engaging in behaviors that increase their risk for HIV and other STIs. Few attend college and, in the rural South, job opportunities that lead to stable occupations are scarce. With no stake in conventional educational or occupational systems, the transition to the workforce can be demoralizing and protracted. Some who see no pathway to adequate subsistence or attainment of personal goals may experience increases in anger and other negative emotions that encourage substance use; undermine stable, monogamous relationships; and compromise protective sexual behavior. Based on the Institute of Medicine's (IOM) prescription for prevention science, the development of effective prevention programs requires etiological models that link contextual factors with proximal risk and protective mechanisms that forecast HIV-related risk behavior in a specified target population. Currently, this information does not exist for African American MSW in general or rural MSW in particular. Although program developers may create or adapt programs for rural African American MSW without the necessary scientific data, implementing programs that are not based on sound etiological models will undermine their public health impact. Consistent with IOM recommendations, the proposed research will provide the necessary next step for the development of efficacious HIV prevention interventions for rural African American MSW during young adulthood. We propose to sample 500 rural African American men age 18-21 who live in a region of central Georgia typical of areas in the rural South with large proportions of African American residents. Men from this region will provide survey data 3 times at 12-month intervals. The conceptual model that guides the study incorporates the following processes: (a) contextual risk factors including economic opportunities and stressors, racial discrimination, and risk-promoting peer affiliations and norms; (b) proximal risk mechanisms including negative emotionality, risk-promoting masculine ideology, and sexual relationship dynamics; (c) protective factors including racial pride, self-regulatory competence, and risk-deterring relationships with parents and informal mentor figures, and (d) HIV-related behaviors including substance use, unprotected intercourse, and multiple and concurrent sexual partnerships.
Understanding the personal and environmental factors that contribute to rural African American men's HIV- related risk behavior is critical for prevention efforts to deter HIV. In this study we will recruit a sample of young African American men living in resource poor rural communities. Information from this research will assist in the development of scientifically based programs for this population.
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