Decades into the US HIV epidemic, Black men remain at disproportionate risk for HIV and comprise the majority of men infected via heterosexual transmission. Recent research indicates that social factors, poverty, unemployment and homelessness, facilitate HIV risk among Black men but have rarely been addressed via HIV intervention. Community providers and activists recommend the use employment and housing support to promote HIV risk reduction in Black communities, and empirical evidence supports use of such an approach, typically involving case management. However, application of this model to clinical settings reaching at risk Black men has been limited. The proposed study is designed to develop an HIV prevention model comprised of 6 months of employment and housing case management and HIV risk reduction counseling (the MEN Count Program- Making Employment and Housing Needs Count) for heterosexual Black men and b) to assess the feasibility and acceptability of the MEN Count model in a UCHC setting and with heterosexually at risk Black men (i.e., reporting unprotected sex, sex with 2 or more female sex partners, and at least 1 homeless night in the past 6 months;currently not employed full-time). To inform program development, Phase 1 of this study will involve formative research in the form of focus groups with eligible at risk Black men (3 groups) and health and social service providers for these men (2 groups);groups will provide feedback on relevant content and approaches for UCHC HIV intervention for at risk Black men. Phase 2 of the study will involve HIV intervention protocol development with our community-provider-academic team of experts, all of whom have been involved with program and curriculum development for this population. During protocol development, we will also finalize construction of our evaluation tools, and subsequent to this development, we will hire and train intervention staff, pilot our intervention and evaluation tools, and refine tools and protocols for the feasibility study. Phase 3 of the study will be undertaken in Year 2 and will involve implementation and feasibility testing of the MEN Count program, using a two-arm randomized control trial with 100 eligible men from our target population. Participants will be randomly assigned to either MEN Count or the Comparison condition, which will involve HIV risk reduction case management for 6 months within the UCHC setting. Participants will be assessed via surveys at baseline, mid-program (3 months post-baseline), and posttest (6 months post-baseline) to assess intervention versus comparison group effects on housing and employment, more proximal safer sex mediators. Exploratory analyses will be conducted to obtain parameter estimates on desired program outcomes (sexual risk behaviors and HIV/STI) to determine effect sizes for planning a larger, efficacy trial. A Process Evaluation will also be conducted to ensure quality control, to document program recruitment, implementation and retention, and to assess participants'response to the program. This study will be developed and implemented via a Community-Based Participatory Research approach.
HIV disproportionately affects Black communities in the US, but to date there have been very few HIV interventions demonstrating effectiveness with heterosexual Black men. The proposed study involves development and pilot testing of a clinic-based HIV intervention for heterosexual Black men. Building on existing community-based participatory research of the proposed investigator team, the proposed intervention is designed to address both individual risk for HIV (e.g., HIV risk perceptions and safer sex self-efficacy) as well as contextual risk factors (i.e., unemployment and homelessness).
