The critical task of emerging adulthood, the life period when risk-behaviors peak, is the development of an integrated adult identity (professional, sexual and cultural). For young Hispanic men who are having sex with men (YHMSM) developing a gay identity in a culture whose traditional norms stigmatize and reject homosexual thoughts, feelings and behaviors and that expects strong adherence to cultural norms, this process can be particularly challenging and risky. Not only does it entail participating in behaviors that are not generally accepted by mainstream Hispanic culture, but they are doing so in Miami, a context where HIV prevalence among MSM is high. Urgently needed for YHMSM are tailored interventions that utilize effective, flexible approaches such as Motivational Enhancement Interventions (MEIs) that can be delivered through the Internet, a modality thoroughly embraced by young adults and one that offers much promise for intervention research. In this Stage 1a/b study, we will develop and pilot test a culturally and developmentally tailored MEI to reduce risky sex (unprotected anal sex and multiple partners) among YHMSM to be delivered face-to-face (FtF) and through the Internet using a real-time implementation approach. In Stage 1a, we will collect quantitative and qualitative data to identify the cultural, developmental, and personal factors associated with risky sex in YHMSM, develop a tailored MEI for two delivery modalities, and a health education control (HEALTH) comparable in time and number of sessions. We will recruit across-sectional sample of 100 YHMSM from community and Internet venues to complete an ACASI. We will supplement these data with 25 qualitative interviews, 10 key informant interviews and 6-8 focus groups to guide intervention development. In Stage 1b, we will test the newly developed MEI's acceptability and feasibility, obtain effect size estimates of the intervention's strength to reduce risky sex, and determine if it is ready to be moved to Stage 2 for efficacy testing. We will recruit a total of 90 YHMSM from community and Internet venues and randomly assign them to one of the 3 conditions (MEI-FtF;MEI-lnternet;HEALTH). Participants will complete assessments using ACASI at baseline, 3 and 6 month post intervention. After each session, they will complete acceptability and feasibility assessments. If the pilot trial shows promise, we will be well positioned to move the intervention to full-scale efficacy testing and advance prevention efforts for YHMSM.
