African American inner city men who have sex with men (MSM) have some of the highest HIV rates in the U.S. Our research indicates that among African American MSM, Baltimore has the highest HIV rates. For over a decade our research team has conducted extensive epidemiological research and voluntary HIV counseling and testing for African American MSM. We have also collaborated for 15 years on developing and testing highly successful models of HIV prevention intervention for inner city African Americans. Culturally relevant HIV prevention interventions are urgently needed for this often """"""""hidden"""""""" population of African American MSM. While individually-oriented cognitive behavioral intervention approaches have shown some efficacy in HIV/STI risk reduction, the persistence of HIV among MSM indicates the need for enhancements of these HIV prevention approaches. Peer outreach strategies and social network-oriented influence approaches to intervention have demonstrated efficacy in HIV risk reduction among hard-to-reach African American drug using populations. Based on a social influence framework, with theories of social diffusion, social norms, and social identity, our prior SHIELD intervention used peers to promote risk reduction within their social networks. We propose a network-oriented, peer outreach intervention based on our SHIELD study, representing a theory-based, social enhancement of cognitive behavioral intervention approaches. The study is designed to reach African American MSM with a diversity of identities, and levels of comfort in sexual identities and in affiliating with HIV prevention projects. By capitalizing on social influence processes, network-oriented approaches to intervention may be effective in reaching high-risk African American MSM who may not identify as gay or frequent gay-identified venues. The proposed study design is a randomized controlled phase II efficacy trial. African American MSM (Index) participants (n=300; 150 per arm) randomly assigned to the experimental condition will receive skills training to conduct peer outreach focused on HIV prevention among their African American male network members. The training will emphasize communication strategies for promoting network member peers' sexual risk reduction and HIV testing. The equal-attention control condition will be based on project RESPECT, augmented by additional sessions for equal attention. Eligibility criteria will include being a sexually active African American MSM, and being able to recruit to the study at least one high risk African American MSM network member with whom one has at least weekly contact. Outcome evaluation will include pre-test and 3-month post- intervention assessments. Outcome measures will be self-reported sexual risk behaviors and HIV testing. Urinalysis of gonorrhea and chlamydia at baseline and follow-up will be used as additional measures of sex risk. We will also assess potential diffusion of intervention effects to participants' social network members. ? ? ?
