The Centers for Disease Control and Prevention (CDC) has termed AIDS a """"""""health crisis"""""""" for African Americans and has called for a heightened national response. The crisis is especially dramatic in the South and it is now apparent that young African American men who have sex with men (MSM) are exceedingly likely to be infected. Unfortunately, the ever-expanding HIV epidemic experienced by this population has not been matched by equal attention to the development of efficacious prevention programs. The proposed project expands upon an NIMH-funded study (R21 MH066682-01A1) conducted by Dr. Crosby. His study of young African American males found that a brief, clinic-based intervention reduced incidence of subsequent STDs by about 50%. This brief, one-on-one, intervention program, known as Focus on the Future (FOF), is a practical alternative to group-based safer sex programs that can be difficult to translate from science into practice. The program is now classified as a """"""""Best Practice"""""""" intervention by CDC. This project will begin with an extensive formative phase designed to adapt FOF to MSM. The adapted program will seek to """"""""sexualize"""""""" condoms to promote their consistent and correct use to better prevent STD/HIV. The program is uniquely flexible in that it can be applied to MSM regardless of their HIV serostatus. The adapted program will be tested by a two-arm efficacy trail. We will recruit 750 MSM (15-29 years of age) from a publicly-funded STD clinic in Jackson MS. Men in the treatment condition will be compared to men receiving the control condition comprised of standard of care counseling from the clinic plus a free ditty bag of supplies from the """"""""condom and lube buffet"""""""" (condom/lube distribution). The trial will test five hypotheses. Men randomized to receive the intervention will: 1) have a lower incidence rate of laboratory-confirmed STDs (by urine assay and rectal swab) at each of three follow-up assessments (3, 6, and 12 months) compared to controls;2) report significantly fewer acts of unprotected penetrative sex (penile-vaginal or penile-anal) between follow-up assessments compared to controls;3) report having significantly fewer unprotected penetrative (penile-vaginal or penile-anal) sex partners between follow-up assessments compared to controls;4) report having significantly fewer negative experiences with condom use between follow-up assessments compared to controls;and 5) demonstrate significantly greater improvement in condom application skills, throughout the 12-month study, compared to those receiving the control condition. Given the dearth of evidence-based options for intervening with this vulnerable population in clinical settings, demonstrated efficacy of the adapted program has important implications for public health efforts to prevent STD/HIV. The adapted FOF is also directly responsive to the President's National HIV/AIDS strategy, particularly with regards to the target population of this proposal.

Public Health Relevance

The proposed efficacy trial will occur in Jackson, MS and it tests a brief, clinic-based, HIV/STD prevention program adapted specifically for young African American MSM. This program is based on a CDC-classified Evidenced-Based Intervention known as Focus on the Future. The randomized trial is designed with 3 follow-up assessments and it uses biomarker outcomes as well as a novel method of collecting self-reported outcomes.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Kamath, Susannah M Allison
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University of Kentucky
Public Health & Prev Medicine
Schools of Public Health
United States
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Crosby, Richard A; Sanders, Stephanie A; Graham, Cynthia A et al. (2017) Evaluation of the Condom Barriers Scale for Young Black Men Who Have Sex With Men: Reliability and Validity of 3 Subscales. Sex Transm Dis 44:91-95
Crosby, Richard A; Mena, Leandro; Arnold, Trisha (2017) Disclosure of newly diagnosed HIV infection and condom use at first sex after diagnosis: a study of young Black men who have sex with men. Sex Health 14:325-330
Crosby, Richard A; Mena, Leandro; Ricks, JaNelle M (2017) Correlates of sexual-risk behaviors among young black MSM: implications for clinic-based counseling programs. AIDS Care 29:718-723
Mena, Leandro; Crosby, Richard A (2017) Portrait of an Epidemic: Extremely High Human Immunodeficiency Virus Prevalence and Incidence Among Young Black Men Having Sex With Men and Residing in a Southern City. Sex Transm Dis 44:401-402
Mena, Leandro; Crosby, Richard A; Geter, Angelica (2017) A novel measure of poverty and its association with elevated sexual risk behavior among young Black MSM. Int J STD AIDS 28:602-607
Chamberlain, Nicholas; Crosby, Richard A; Mena, Leandro et al. (2017) Is Patient-Reported Exposure a Reliable Indicator for Anogenital Gonorrhea and Chlamydia Screening in Young Black Men Who Have Sex With Men? Sex Transm Dis 44:390-392
Crosby, Richard A; Mena, Leandro; Geter, Angelica (2017) Are HIV-positive young black MSM having safer sex than those who are HIV-negative? Int J STD AIDS 28:441-446
Chamberlain, Nicholas; Mena, Leandro A; Geter, Angelica et al. (2017) Is Sex with Older Male Partners Associated with Higher Sexual Risk Behavior Among Young Black MSM? AIDS Behav 21:2526-2532
Crosby, Richard A; Mena, Leandro; Geter, Angelica (2016) Favourable attitudes towards serosorting are associated with overall less frequent condom use among young Black men having sex men. Sex Health 13:91-2
Crosby, Richard A; Graham, Cynthia A; Mena, Leandro et al. (2016) Circumcision Status is Not Associated with Condom Use and Prevalence of Sexually Transmitted Infections Among Young Black MSM. AIDS Behav 20:2538-2542

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