2003 National HIV Prevention Conference

Translating Evidence-based Interventions for Use by
Community-Based Organizations Serving Gay, Bisexual, and
MSM Latino and African American Populations

Myrick, RK1; Ayala, G2; Kegeles, SM3; Rebchook, GM3; Aoki, B1;
Truax, S4; Lemp, GF1; Rasmussen, H4; Johnson, D4
1 Universitywide AIDS Research Program/University of CA/Office of
the President, Oakland, CA; 2 AIDS Project Los Angeles, Los
Angeles, CA; 3 University of California San Francisco, Center for
AIDS Prevention Studies, San Francisco, CA; 4 California State
Office of AIDS, Sacramento, CA

ISSUE: There is a critical need to reach gay, bisexual, and MSM of color
with effective HIV prevention interventions. Given the paucity of
tested interventions that have been developed for these populations,
research is needed on how to effectively translate evidence-based
interventions to gay, bisexual, and MSM of color. This group oral
session will address this issue, and will include presentations from a
funder and researchers involved in translation research.
SETTING: Community-based organizations serving gay, bisexual, and
MSM Latino and African American populations in California
PROJECT: The California Prevention Evaluation Initiative (CPEI) – a
community collaborative research funding partnership between the
Universitywide AIDS Research Program, University of California,
Office of the President, and the California State Office of AIDS – is
funding a unique research project to study the process of translating and
implementing evidence-based HIV prevention interventions for gay/
bisexual/MSM populations who engage in behaviors that may
potentially transmit HIV.
RESULTS: Two multi-site projects were selected through a
competitive external review process: one project is studying how the
Mpowerment Project can be translated for use by organizations serving
young, Black, Same Gender Loving men; and one project is studying the
process of translating the Street Smart Intervention for use by Latino
gay, bisexual, and MSM populations. This panel will include
presentations from investigators working on these projects and from
the funder, and will focus on the following topics: issues critical for
translating research into practice for the above populations; effective
processes for developing collaborative relationships among research
and community partners; translation strategies that are being used to
adapt research based interventions for use by community organizations;
and evaluation methods that support translation research.
LESSONS LEARNED: Research on translating research into practice
provides much needed information on strategies that can be used to
adapt evidence-based interventions for applied use by community
organizations. In the context of limited research and tested interventions
for gay, bisexual and MSM communities who continue to bear the brunt
of the epidemic, such research is critical for a strategic response.
G(r )aying: Exploring Contexts for HIV Prevention Interventions
Among 50+ MSM’s.

Coon, DW1; Catania, JA2; Rebchook, GM2
1 Institute on Aging, San Francisco, CA; 2 University of California
San Francisco Center for AIDS Prevention Studies, San Francisco, CA

BACKGROUND/OBJECTIVES: MSM still constitute the
overwhelming majority of HIV/AIDS cases in the 50 and older
population. However, older MSM’s sexuality and primary prevention
needs, as well as their unique situations and contexts for HIV risks, are
relatively unexplored. This formative research examines key themes to
aid in the development and evaluation of HIV interventions for older
MSM’s.
METHODS: MSM 50 years of age and older who reported having male
sexual partners in the last 5 years were invited to participate in either a
focus group or an in-depth individual interview. Men were identified
through their participation in a recent probability based epidemiological
study of adult MSM residing in San Francisco, as well as through
snowball sampling and local advertisements. The project systematically
gathered data to clarify our understanding of older MSM’s HIV risks
and the contexts that place them at risk for HIV transmission.
RESULTS: 85 eligible MSM’s age 50 and over participated in the project.
Recruitment resulted in a substantially diverse sample with 63.5% of the
study participants being age 50-59, 36.5% over age 60, and 33% of the total
sample self-identifying as MSM of color (10.8% Latino/Hispanic, 12.9%
African American, 4.7% Asian/Pacific Islander; 3.5% Native American and
1.2% as multiracial). Fifty-five MSM participated in five separate focus
groups and 30 in in-depth interviews. Participants ranged in age from 50 to
80 (mean age = 57.9 years), and reported an average of 8.8 sexual partners in
the last year. Approximately a third of all participants were in a committed
relationship. Several key themes emerged including: pervasive internalized
and externalized ageism; social support losses due to the AIDS epidemic
(particularly among 50-59 year olds) and other social losses that increase
loneliness, limited social venues for older MSM; an increased desire for
intimacy; and, an interest in mentoring opportunities to give back to
younger generations of MSM.
CONCLUSIONS: Results suggest new HIV campaigns need to be
launched that target older MSM. These interventions need to address
the tremendous stigma older MSM experience in the community as well
as a number of their social and informational needs (e.g., housing,
medical, sexual functioning and financial needs). Providing mentoring
opportunities with younger generations of MSM’s may prove
beneficial across age groups. Finally, more men in their 50’s reported
substantial losses from the HIV/AIDS epidemic; this and other
differences across cohorts indicate an array of strategies is needed.
Exploring the Sexual Behavior and Internet Use of Chatroom-
Using Men Who Have Sex with Men (MSM) through Online
Qualitative and Quantitative Research.

Rebchook, GM; Curotto, A; Kegeles, SM
Center for AIDS Prevention Studies/UC San Francisco, San Francisco,
CA

BACKGROUND/OBJECTIVES: High rates of unprotected anal
intercourse (UAI) have been reported among MSM who use the
Internet to meet sexual partners. This online study describes chatroomusing
MSM’s Internet use and sexual behavior, and gauges the
feasibility of future online HIV-prevention interventions.
METHODS: We recruited MSM from Internet chatrooms to
participate in an online qualitative interview and brief online survey.
The recruiter entered gay-oriented chatrooms to advertise his presence
and describe the study. Interested men contacted him via Instant
Messaging or similar technologies. Potential participants were then
screened for eligibility. Participants gave their consent electronically
before taking a web-based survey and completing a 1-2 hour online
interview in real time.
RESULTS: Participants’ mean age was 31 (range 18-52; n=91). Their
race/ethnicity was: 47% white, 23% Latino, 12% African American,
11% Asian/Pacific-Islander. 38% had at least a college degree. 73%
identified as gay and 25% as bisexual. 74% reported being HIV-negative,
and 11% HIV-positive. While 33% reported having a boyfriend, only
27% (n=8) of these men were in mutually monogamous relationships
lasting > 6 months. These 8 men were excluded from the remaining
descriptive analyses. Respondents reported an average of 7 sexual
partners in the previous 2 months, and 58% reported UAI. On average,
participants used the Internet 20 hours/week for personal purposes.
78% reported, that in the previous 2 months, they had in-person sex
with a man they met online (mean number of partners = 5). 39% of the
men reported UAI with these “online” partners. Preliminary results of
a thematic analysis of the interviews reveal the Internet has allowed
respondents to socialize and to access resources and support
anonymously, and it has been vital to the sexual identity development
and self-expression of many participants. Additionally, many
developed and sustained supportive interpersonal relationships via the
Internet. Respondents felt their online activities have increased their
number of sexual partners and changed their sexual self-expression and/
or practices. A variety of HIV risk-reduction strategies were reported,
including: 100% avoidance of anal sex; 100% condom use for anal sex
with no discussion of HIV status/safer sex; 100% condom use for anal
sex after mutual disclosure/discussion of safer sex. Examples of less safe
behavior include men who: engage in occasional UAI (without
discussing HIV status or condoms); use condoms with their Internet
partners but engage in UAI with “known” partners; have UAI with
Internet partners after mutual disclosure of HIV negative status; and
have UAI with Internet partners with no discussion of HIV status or
condoms unless their partners insist. Many men left condom use
decisions to their partners. Nearly all men said that they would
participate in online prevention programs but were unaware of current
projects.
CONCLUSIONS: The Internet plays an important and multi-faceted
role in the lives of the men in our study. Since study participants spend
a significant amount of time online and report high rates of UAI and
multiple sex partners, the Internet may be a compelling medium through
which to deliver HIV-prevention services to a difficult-to-reach
population.

Positive and Negative Community Reactions towards an
Evidence-based HIV Prevention Program for Young Gay/Bisexual
Men

Rebchook, GM; Kegeles, SM
Center for AIDS Prevention Studies (CAPS)/University of California,
San Francisco, San Francisco, CA

BACKGROUND/OBJECTIVES: The Mpowerment Project is an
effective, community-level HIV prevention program for gay/bisexual
men ages 18-29. It has been rigorously tested in multiple communities
through randomized controlled studies. This study examines qualitative
data regarding program implementation in a city where quantitative
analyses had previously documented that intervention staved off
increases in unprotected sex in the HAART era. The Mpowerment
Project is listed in the CDC Compendium of HIV Prevention
Interventions with Evidence of Effectiveness and was named an
Exemplary Program by SAMHSA’s Center for Substance Abuse
Prevention.
METHODS: We implemented the intervention in a medium-size,
Southwestern City from 6/97 to 5/98. A local CBO is still running the
program. We measured program effects with a longitudinal cohort
recruited independently of the intervention. 193 men returned the postintervention
survey, and 118 of them answered a free-response question
about their feelings towards the program.
RESULTS: Respondents’ mean age was 25, and their race/ethnicity
was: 48% white, 40% Hispanic, 7% Native American, 4% Black, 1%
Asian/Pacific Islander. 35% had at least a college degree. 87% identified
as gay, and 11% as bisexual. 83% reported being HIV-negative, and 4%
were HIV-positive. Two coders independently conducted a thematic
analysis of the free-response questions. Preliminary results found that
50% of responses were exclusively positive; 21% were negative; 14%
were mixed; and 14% were neutral. The most frequent positive themes
included appreciation for the program’s: a) safe venue; b) alcohol/drug
free environment; c) fun, community building activities that created new
and supportive friendships; d) safer sex and health promotion; e) sincere
philosophy and desire to improve the community; and f) positive
impact on young gay/bisexual men (e.g., increased self-esteem, healthy
sexual identity development). Some respondents wished that a similar
Project existed when they were younger, expressed desire to see similar
Projects in more cities, or complimented the Project staff. Common
negative themes were perceptions that the program: a) overly
emphasized sex rather than other aspects of men’s lives; b) had members
(or sometimes staff) who acted immaturely, unfriendly, or “catty”; c)
seemed like a clique; d) had a social atmosphere in which participants
only wanted to meet sexual partners; and e) did not sufficiently impact
local young gay/bisexual men. Other men wrote that the Project was too
focused on HIV, too “gay,” had inappropriate or ineffective publicity, or
basically just needed to do more.
CONCLUSIONS: Even a program previously shown to be effective
needs to continuously assess the implementation process. Successful
community-building and empowerment programs need to maximize
positive qualities, such as 1) creating safe, welcoming, and inclusive
venues and activities; 2) developing healthy community norms that
support safer sex; and 3) empowering the community to be involved in
their own solutions to difficult issues. Community building programs
must work against social forces that are destructive to community
development (e.g., the formation of “elitist cliques”). Exclusionary
attitudes and actions that interfere with healthy group processes should
be identified and addressed before they have the opportunity to taint
community perceptions and interfere with effective community-level
HIV prevention.

Translating Research into Practice: Experiences of an Evidence-
Based Community-Level HIV Prevention Intervention for Young
MSM

Kegeles, SM; Rebchook, G
Center for AIDS Prevention Studies, University of California, San
Francisco, CA

ISSUE: The Mpowerment Project (MP) is an effective, communitylevel
HIV prevention program for gay/bisexual men ages 18-29. It has
been rigorously tested in multiple communities through randomized
controlled studies. It is listed in the CDC Compendium of HIV
Prevention Interventions with Evidence of Effectiveness and was
named an Exemplary Program by SAMHSA’s Center for Substance
Abuse Prevention. Over 300 community-based organizations and health
departments (CBOs/HDs) have requested assistance in implementing
the MP. The issues addressed here are: 1) How can a research-based
HIV prevention intervention be translated into practice, and 2) What
can be done to facilitate the intervention’s successful implementation.
SETTING: The site of the intervention developers and the CBOs/HDs
that request assistance in translating the MP into practice.
PROJECTS: Four projects will be discussed: 1) the original research
and subsequent efforts with CBOs and funders in the research
communities to sustain the intervention after the randomized,
controlled trials ended, and characteristics of the MP that influence the
translation process; 2) experiences in the REP project, including the
development of a preliminary replication package collaboratively
produced by working with 9 CBOs/HDs; 3) a collaborative research
project with a CBO, in which the CBO implemented the intervention; 4)
an ongoing project involving state-of-the-art methods of training,
technical assistance (TA) and replication materials in collaboration with
CBOs/HDs around the U.S. seeking to implement the MP. The
effectiveness of the TA/training program is being evaluated and the
project also involves studying factors, including characteristics of MP,
that present as barriers and facilitators to successful implementation.
RESULTS: The intervention is complex—it is theoretically
sophisticated, involves multiple interrelated components, requires
empowering young MSM as decision-makers, and uses communityorganizing
methods. But current theories about MSM and sexual risk
behavior indicate that complex interventions are required to match the
complex sociocultural contexts of sexual behavior and psychosocial
issues affecting young MSM. Effective translation to practice depends
upon the quality of the implementation, which has never been examined
previously. We found that replication materials alone were insufficient
to effectively translate research to practice. Yet replication materials
must provide abundant examples of implementation and guidelines to
follow, while not dictating exactly how to implement the program.
Training must be intensive and experiential, and involve CBOs/HDs
sharing their experiences with each other. TA must be individuallytailored
to the CBOs/HDs’ unique characteristics, communities, and
stage of implementation, Also, it must be provided on a regular basis,
not solely when CBOs/HDs recognize the need for it. Organizational
issues must be taken into account in replication materials, training, and
TA.
LESSONS LEARNED: Effectively translating the evidence-based,
community-level MP into practice requires a “second generation
intervention,” in which the intervention is focused on CBOs/HDs that
want to implement the Mpowerment Project. This new intervention is
called “The Mpowerment Project Technology Exchange System,”
(MPTES) and involves extensive collaboration with CBOs/HDs. In
addition to replication materials, training and TA, it also involves a
website, an internet chat room about the intervention, and an electronic

Project EXPLORE: Researcher Collaboration in Recruiting High
Risk MSM

Barresi, P1; Bozeman, S2; Camacho, M3; Gage, R4; Osteen, P5;
Powers, C6; Verano, P7; LeBlanc, D8; Borris, P6
1 University of California, San Francisco, San Francisco, CA; 2 Abt
Associates, Cambridge, MA; 3 New York Blood Center, New York,
NY; 4 San Francisco Dept of Public Health, San Francisco, CA; 5
Denver Dept of Public Health, Denver, CO; 6 Howard Brown Health
Center, Chicago, IL; 7 University of Washington, Seattle, WA; 8
Fenway Community Health Center, Boston, MA

ISSUES: We describe the combination of national and local resources in
recruiting high risk men who have sex with men (MSM) and offer
recommendations for similar nationwide, multi-site trials and programs.
SETTING: EXPLORE was conducted at six domestic U.S. sites:
Fenway Community Health Center (Boston, MA;) Howard Brown
Health Center (Chicago, IL;) Denver Department of Public Health
(Denver, CO;) New York Blood Center (New York, NY;) San Francisco
Department of Public Health (San Francisco, CA;) and University of
Washington – HPTU; (Seattle, WA.)
DESCRIPTION: EXPLORE is a randomized controlled trial of a
counseling intervention to prevent HIV infection among MSM.
Enrollment target was 4,350 (approximately 725 per site.) 98.7 % was
attained between February 1999 and February 2001.
LESSONS:
1.Share best practices across study sites. Use conference calls and
annual meetings.
2.Assess strategies continually – be flexible in choice of foci. Rotate foci
to keep the study ‘fresh’ in the public’s mind.
3.Use multiple strategies (e.g., multi-media advertising, person-toperson
outreach in venues likely to attract eligible participants,
mailings, etc.) consistently throughout the accrual period to keep the
study in the public eye.
4.Employ social marketing principles for planning and fielding of
recruitment.
5.Deploy socially and culturally relevant recruiters consistently.
6.Reinforce consistent presence with strong advertising.
7.Allocate sufficient resources – marketing, advertising, and appropriate
staff
EXPLORE researchers collaborated to reframe working assumptions
about best staffing (e.g.,hourly workers were more effective than parttime
staffers;) required resources for staff and advertising; marketing of
EXPLORE to MSM through multiple channels; recruitment plans and
goals, and the efficient division of labor at sites. Centralized
coordination of this approach and local coordination of local recruitment
activities were critical.
RESULTS: 8,150 pre-screens were conducted: 74% completed
screening appointments and 89% of screened subjects enrolled
(N=4,295). Ethnically and age diverse MSM were recruited: 61% 35
years or younger; 7% Black, 15% Hispanic; as well as high risk — 42%
had >10 partners in past 6 month period, 10% IDUs, 28% sex with
HIV+ male, 27% unprotected anal sex with partner of unknown status.
Best sources for recruitment included clubs (23%), ads (14%), mailings
(14%), and peer referrals(14%),
RECOMMENDATIONS: Resources invested locally are strongly
enhanced with concurrent inter-site communication and coordination.

Missed Opportunities for Preventing HIV Transmission:
Rationale for the Special Projects of National Significance
(SPNS) Initiative on Prevention with HIV-Infected Persons Seen
in Primary Care Settings

Morin, S1; Koester, KA1; Maiorana, A1; McLaughlin, M1; Myers,
JJ1; Steward, WT1; Vernon, K1; Kahn, JO1; Chesney, M1; Malitz,
FE2; Bush, C2; Duggan, S2; Eldred, L2
1 AIDS Policy Research Ctr. ARI, University of California, San
Francisco, San Francisco, CA; 2 Health Resources & Services Adm.,
HIV/AIDS Bureau, Rockville, MD

ISSUE: HIV primary care settings provide a venue for prevention
activities with HIV-infected individuals.
SETTING: 16 Ryan White CARE Act funded clinics in 9 states and
primary care settings serving at least 300 HIV-infected clients per year
and providing continuing, comprehensive, and preventive personal
medical care.
PROJECT: The Ryan White CARE Act Prevention Project assessed
current practices of providers regarding prevention with HIV-positive
patients in CARE Act primary care settings, barriers to providing such
services, and perceptions of patients regarding their need for such
services. Interviews regarding services received were conducted with
618 HIV-positive patients after exiting a primary care visit. In addition,
qualitative interviews were conducted with 16 clinic administrators, 32
primary care providers, 32 support service providers and 64 patients
recruited from the 16 clinics. Results from this study led to the
development of the SPNS HIV Prevention Initiative. Under this
initiative, demonstration sites select, implement and evaluate
interventions with HIV-positive individuals in primary care settings.
The goal of the initiative is to determine if behavioral interventions in
primary care clinical settings help HIV-positive clients reduce the risk
of transmitting HIV to others. A typology characterizing the initiative’s
prevention interventions will be presented. Components such as
behavioral risk assessment, behavioral intervention, training protocol,
model fidelity and intensity and duration of the intervention (dose) will
be compared. An evaluation center (the Center) has been established to
provide support and leadership in the selection, implementation and
evaluation of interventions. The goal is to gain a better understanding of
theory, practice and policy of HIV prevention in primary health care
settings. The Center will coordinate a multi-site evaluation to
determine: the efficacy of the variety of funded interventions; which
models are most appropriate with different populations and in different
settings; cost effectiveness; and, provider and patient behavior change.
The multi-site evaluation design, a web-based data collection system,
technical assistance, and plans for development of communication
networks to support sites in the collection of process, outcome and
impact indicators will be described.
RESULTS: One-quarter of Prevention Project’s participants discussed
“safer sex and ways to prevent transmission to others” with their
provider during that day’s primary care visit. However, only 6%
reported discussing specific sexual activities. Twenty-one percent of
sexually active patients reported being worried that they may have
given HIV to someone else in the last six months. Clinics differed
significantly in the provision of prevention services. Barriers to
providing prevention services identified included lack of time, training,
funding for staffing, and providers’ understanding of their roles and
responsibilities.
LESSONS LEARNED: HIV primary care settings may provide an
opportunity to reduce new transmissions during regular clinical
encounters. However, the Prevention Project revealed that the concept
of “prevention with positives” is not clearly understood or defined in
most clinics, and such services are not routine on an ongoing basis.
Before evidence based HIV prevention interventions can be established,
administrators, providers and patients must agree that this activity is
consistent with the clinic’s role and decide who is responsible for
delivering the service.
HIV Transmission Risk Behavior, Medication Adherence, Mental
Health, and Substance Use in a Four-City Sample of People
Living with HIV: Implications for HIV Prevention – Findings
from the NIMH Healthy Living Project

Rotheram-Borus, M1; Kelly, JA2; Ehrhardt, AA3; Chesney, MA4;
Lightfoot, M1; Weinhardt, LS2; Kirshenbaum, SB3; Johnson, MO4;
Remien, RH3; Morin, SF4; Kertzner, RM3; Pequegnat, W5; Gordon,
CM5; NIMH Healthy Living Project Team
1 University of California, Los Angeles, Los Angeles, CA; 2 Medical
College of Wisconsin, Milwaukee, WI; 3 Columbia University and
New York State Psychiatric Institute, New York City, NY; 4
University of California, San Francisco, San Francisco, CA; 5
National Institute of Mental Health, Bethesda, MD

BACKGROUND: Understanding the behavior of persons infected
with HIV is of critical importance for developing new interventions
aimed at preventing HIV infection. The NIMH Healthy Living Project
is a randomized clinical trial of a psychosocial intervention focusing on
multiple health-related behaviors in persons with HIV. This
presentation provides an overview of the project, reports data on HIV
transmission risk behaviors, medication adherence, mental health, and
substance use from the project’s large and diverse baseline sample, and
will include discussion of the implications of these data for HIV
prevention.
METHODS: In a cross-sectional design, 3,819 HIV infected persons
(including 1,918 men who have sex with men [MSM], 978 women, 827
heterosexual men) were interviewed in clinics and community based
agencies in Los Angeles, Milwaukee, New York, and San Francisco from
April, 2000, to January, 2002. Participants completed multiple indices
of health-related behaviors, mental health status, and substance use. A
computerized interview was used to minimize socially-desirable
responding.
RESULTS: The demographic profile of the sample mirrored that of the
current HIV epidemic in the U.S. With regard to HIV transmission risk
behavior, 19.6% of women, 16.4% of MSM, and 13.9% of heterosexual
men engaged in unprotected vaginal or anal intercourse with partners
who were HIV-negative or whose serostatus was unknown. Eighteen
percent of 303 participants who injected drugs in the past three months
lent their used injection equipment to others (6.3% to HIV-negative or
unknown serostatus persons). Among the 75% of respondents taking
antiretroviral medications, 35% reported missing at least one dose in the
past 3 days, increasing the risk of development of treatment resistant
virus strains. Missed doses were related to several demographic
variables (younger age, African American identity, bisexuality, and
unstable housing) and psychosocial factors (greater substance use and
psychological distress, lower social support, and negative attitudes
about treatment). Depressive symptomatology was mildly elevated,
with a significant minority of participants reporting distress in the
moderate and severe ranges of the Beck Depression Inventory.
Psychological distress was associated with HAART non-adherence,
alcohol and illicit drug use, and sexual transmission risk behavior.
Women had higher levels of Anger-Burnout, levels of stress, and impact
of HIV/AIDS symptoms on their lives compared with men. Bisexual
men reported higher levels of Anger-Burnout and lower Positive States
of Mind scores compared with heterosexual and homosexual men. Forty
percent of participants recently used substances at an abusive level,
32% at a recreational level, and 28% abstained. Significant predictors
differentiating substance use level included gender, ethnicity, sexual
orientation, social support, and depression. Factors associated with
reduction in level of substance use (from lifetime to recent) included
gender, city, ethnicity, education, social support, and quality of life.
CONCLUSIONS: Intensive prevention programs for persons with
HIV infection, which include attention to transmission risk behavior,
mental health issues, medication adherence, and substance use, in
addition to the more traditional approaches of HIV-test counseling and
of focusing on HIV-negative persons, are needed to prevent future
infections. Such an intervention model, currently being evaluated in the
NIMH Healthy Living Project, will be described.

Sexual Behavior Among HIV-Seropositive Men Who Have Sex
with Men: What’s in a Label?

Hart, TA1,2; Wolitski, RJ1; Purcell, DW1; Gomez, C3; Halkitis, P4
1 Centers for Disease Control and Prevention, Atlanta, GA; 2 Emory
University, Atlanta, GA; 3 University of California, San Francisco,
San Francisco, CA; 4 New York University, New York City, NY

BACKGROUND/OBJECTIVES: Although there is an extensive
literature documenting the prevalence of specific sexual practices among
men who have sex with men (MSM) these studies provide little insight
into MSM’s identification with, and preference for, specific roles
during sexual intercourse. This study examines the relation between sex
role label, and HIV transmission risk and psychological functioning
among HIV-seropositive MSM.
METHODS: Data were collected as part of the Seropositive Urban
Men’s Study, which was designed to examine factors associated with
safer sex behaviors among HIV-seropositive MSM. Participants (n =
205) were recruited from community venues and were administered an
interview that included questions about their sexual practices,
substance use, and other risk-related issues. Participants were also
asked if they identified as a “top,” “bottom,” or “versatile,” (indicating
preference for insertive anal, receptive anal, or both forms of anal
intercourse). Participants were also given the option of indicating they
did not identify with any of the three self-labels.
RESULTS: Seventy-one percent of participants were men of color, and
they ranged in age from 21 to 62 years (M = 37.5, SD = 7.7). Of the 205
participants, 36 (18%) self-identified as tops, 47 (23%) as bottoms, 97
(47%) as versatiles, and 25 (12%) reported that these labels did not
apply to them (hereafter referred to as the “no label” group). Tops were
more likely to engage in insertive anal intercourse than bottoms, and
bottoms were more likely to engage in receptive anal intercourse than
tops, with versatiles reporting intermediate rates of both behaviors.
However, self-label groups were highly overlapping in sexual behavior,
with 41% of tops engaging in receptive anal intercourse and 39% of
bottoms engaging insertive anal intercourse in the past 3 months.
Further, among those who engaged in insertive or receptive anal
intercourse, there were no differences among self-label groups in
prevalence of unprotected sexual behavior. Self-label also predicted
several psychological variables even when controlling for differences in
sexual behavior among self-label groups. Tops were less likely to
identify as gay (OR = 0.25, 95% CI = 0.07 – 0.87) and had higher
internalized homophobia (F (1, 96) = 16.25, p < 0.001) than versatiles.
Versatiles had higher sexual sensation seeking (F (1, 111) = 8.07, p <
0.01) and lower anxiety than the “no label” group (F (1, 114) = 19.47, p
< 0.001).
CONCLUSIONS: The data show that identification with a self-label
(top, bottom, or versatile) is common among HIV-positive MSM. Selflabel
groups were highly overlapping in sexual behavior, suggesting that
self-labels may be inadequate as proxies for asking about actual sexual
behavior. However, self-label appears to provide some insight into the
psychological adjustment of HIV-positive MSM.

The Gender-Economic Model (GEM) of HIV Risk for Women of
Color

Gomez, CA
University of California, San Francisco, San Francisco, CA

BACKGROUND: The HIV/AIDS pandemic in the United States has
steadily been increasing among women of color, particularly African-
American and Latina women. In just over a decade, the proportion of
AIDS cases reported among adult and adolescent women has more than
tripled. Most HIV prevention interventions for women have not
incorporated cultural and social factors such as sexual gender norms and
socioeconomic status as they relate to increased vulnerability to HIV.
These trends may suggest that current HIV prevention interventions are
continuing to have limited success in decreasing the risk of HIV infection
among African-American and Latina women. The purpose of this study
is to assess the extent to which the intersection of socio-culturally
prescribed sexual gender norms and socioeconomic context are
associated with sexual risk behaviors among African-American and
Latina women. Lacking in HIV prevention research for women is an indepth
understanding of how women from different socioeconomic
contexts and different levels of compliance to sexual gender norms differ
in regards to their sexual risk behaviors and prevention-related skills.
Unless there is a basic understanding of how these two important
constructs interact with each other and with previously studied
predictors of condom use (e.g., self-efficacy, peer norms), we are limited
in our ability to appropriately target HIV prevention interventions for
women.
METHODS: Phase I of this three-phased study consists of formative
qualitative data including focus groups and individual interviews with
Latina and African-American women regarding their perceived role of
socio-economic context and gender role expectations on HIV and STD
vulnerability for women. Results being presented include our current
knowledge to-date of these issues in the HIV prevention field, as well as
the analyses of focus groups conducted with both English- and Spanishspeaking
Latina women, and with African-American women from
different socio-economic contexts.
RESULTS: Ten focus groups were conducted to elicit views towards
the following themes: sexual gender norms for men and women; the role
of economic resources in women’s decisions regarding sexual risk;
motivation women have to maintain relationships with men; and the role
of HIV and STD prevention as a priority in their life. Fifty-seven
women participated in focus groups. Important differences emerged
regarding the experience of gender roles for Latina and African-American
women. In addition, younger women are more likely to view themselves
as having more options and power in heterosexual relationships. Socioeconomic
context, including social capital is perceived as an important
precursor to women’s ability to decrease their vulnerability to HIV and
other STDs.
CONCLUSION: In the formative phase of this prospective study of
Latina and Africa-American women we begin to underscore the
important role of social and structural factors that can make women
more vulnerable to HIV. More complex interventions that can address
women at the individual, dyadic, and socio-cultural level are needed if
we are to stop the on-going increase in the proportion of women
becoming infected with HIV.

Why HIV Infections Have Increased Among Men Who Have Sex
with Men and What to Do About It

Morin, SF; Vernon, K; Harcourt, J; Steward, WT; Volk, J; Riess, TH;
Neilands, TB; McLaughlin, M; Coates, TJ
University of California, San Francisco, San Francisco, CA

BACKGROUND/OBJECTIVES: A resurgence of sexual risk-taking,
STDs and HIV incidence has been reported among men who have sex
with men (MSM) in several countries. We conducted this study to
better understand what MSM perceive as the reason why HIV
infections are increasing and what they think can be done about it.
METHODS: We asked 113 MSM in 12 focus groups conducted in five
California cities—San Francisco, Los Angeles, San Diego, Fresno, and
Sacramento—to identify factors leading to increased risk-taking and
assess prevention messages to reduce risk in this population.
RESULTS: Participants perceived that HIV risk-taking has increased
because 1) HIV is not the threat it once was due to more effective
therapies; 2) MSM communicate less about HIV, and social support for
being safe has decreased; and 3) community norms have shifted such
that unsafe sex is more acceptable. A number of other reasons for risktaking
were identified along with issues specific to MSM of color.
Prevention messages were grouped into themes, and significant
differences were found in the preference rankings of the themes (?2 (4)
= 24.18, p < .001). Across cities, prevention messages ranked most
likely to motivate risk reduction encouraged individuals to seek social
support from friends or countered images presented in pharmaceutical
advertisements. Themes ranked least likely to succeed were those that
described the negative consequences of HIV or reinforced existing safer
sex messages.
CONCLUSIONS: While for many years much of the advocacy among
MSM has focused on treatment, prevention must once again be a central
concern. Fortunately, we have been able to identify several strategies
that hold promise for framing prevention messages and revitalizing
community-level interventions that could respond rapidly to this
reemerging challenge.

Missed Opportunities for Preventing HIV Transmission:
Rationale for the Special Projects of National Significance
(SPNS) Initiative on Prevention with HIV-Infected Persons Seen
in Primary Care Settings

Morin, S1; Koester, KA1; Maiorana, A1; McLaughlin, M1; Myers,
JJ1; Steward, WT1; Vernon, K1; Kahn, JO1; Chesney, M1; Malitz,
FE2; Bush, C2; Duggan, S2; Eldred, L2
1 AIDS Policy Research Ctr. ARI, University of California, San
Francisco, San Francisco, CA; 2 Health Resources & Services Adm.,
HIV/AIDS Bureau, Rockville, MD

ISSUE: HIV primary care settings provide a venue for prevention
activities with HIV-infected individuals.
SETTING: 16 Ryan White CARE Act funded clinics in 9 states and
primary care settings serving at least 300 HIV-infected clients per year
and providing continuing, comprehensive, and preventive personal
medical care.
PROJECT: The Ryan White CARE Act Prevention Project assessed
current practices of providers regarding prevention with HIV-positive
patients in CARE Act primary care settings, barriers to providing such
services, and perceptions of patients regarding their need for such
services. Interviews regarding services received were conducted with
618 HIV-positive patients after exiting a primary care visit. In addition,
qualitative interviews were conducted with 16 clinic administrators, 32
primary care providers, 32 support service providers and 64 patients
recruited from the 16 clinics. Results from this study led to the
development of the SPNS HIV Prevention Initiative. Under this
initiative, demonstration sites select, implement and evaluate
interventions with HIV-positive individuals in primary care settings.
The goal of the initiative is to determine if behavioral interventions in
primary care clinical settings help HIV-positive clients reduce the risk
of transmitting HIV to others. A typology characterizing the initiative’s
prevention interventions will be presented. Components such as
behavioral risk assessment, behavioral intervention, training protocol,
model fidelity and intensity and duration of the intervention (dose) will
be compared. An evaluation center (the Center) has been established to
provide support and leadership in the selection, implementation and
evaluation of interventions. The goal is to gain a better understanding of
theory, practice and policy of HIV prevention in primary health care
settings. The Center will coordinate a multi-site evaluation to
determine: the efficacy of the variety of funded interventions; which
models are most appropriate with different populations and in different
settings; cost effectiveness; and, provider and patient behavior change.
The multi-site evaluation design, a web-based data collection system,
technical assistance, and plans for development of communication
networks to support sites in the collection of process, outcome and
impact indicators will be described.
RESULTS: One-quarter of Prevention Project’s participants discussed
“safer sex and ways to prevent transmission to others” with their
provider during that day’s primary care visit. However, only 6%
reported discussing specific sexual activities. Twenty-one percent of
sexually active patients reported being worried that they may have
given HIV to someone else in the last six months. Clinics differed
significantly in the provision of prevention services. Barriers to
providing prevention services identified included lack of time, training,
funding for staffing, and providers’ understanding of their roles and
responsibilities.
LESSONS LEARNED: HIV primary care settings may provide an
opportunity to reduce new transmissions during regular clinical
encounters. However, the Prevention Project revealed that the concept
of “prevention with positives” is not clearly understood or defined in
most clinics, and such services are not routine on an ongoing basis.
Before evidence based HIV prevention interventions can be established,
administrators, providers and patients must agree that this activity is
consistent with the clinic’s role and decide who is responsible for
delivering the service.

Prevention Needs of HIV+ Individuals: From Assessment to
Intervention Development for HIV Medical Providers

Dawson Rose, C
University of California, San Francisco, San Francisco, CA

The prevention needs of HIV+ individuals are significant and often
inadequately addressed in the clinical setting. Prioritizing HIV
prevention in the HIV clinical setting must include creative ways to
problem solve structural barriers to providing prevention, address the
pressures of current medical practice, and acknowledge the complexity
of prevention for individuals who are HIV+. Data which highlight the
prevention needs of HIV+ persons will be presented. In addition,
assessment data from HIV health care providers will be presented.
These data describe both the needs and barriers that health care
providers identify as important for implementing prevention into the
care setting.
Both of these perspectives are important when implementing HIV
prevention into the HIV care setting.
Casting a Wide Recruitment Net: Motivating Hard to Reach
Communities

Mickalian, JD; Carnes, NA
University of California, San Francisco, Center for AIDS Prevention
Studies, San Francisco, CA

ISSUE: To recruit and enroll 300 HIV– positive people for one urban
site of a multi-site behavioral intervention trial.
SETTING: The San Francisco site used a number of recruitment
sources including agencies, healthcare providers, advertisements,
brochures, recruitment staff, and word of mouth.
PROJECT: Healthy Living Project (HLP) is a collaborative multi-site
clinical trial currently conducted at University of California at Los
Angeles, Columbia University, Medical College of Wisconsin, and
University of California at San Francisco. The purpose of this on-going
study is to design, implement, and evaluate a one-on-one cognitivebehavioral
intervention for people living with HIV to improve their
health and well being. Study participants enroll for 25 months to
complete fifteen one-on-one sessions delivered in 3 modules of 5
sessions each with assessments every 5 months. Each site developed a
unique recruitment plan based on common recruitment language. The
San Francisco site applied social marketing concepts to structure a
comprehensive strategy to target Bay Area communities living with
HIV. This strategy included campaigns targeting distinct communities,
outreach to medical and social service providers, participant word of
mouth, and networking with other studies and projects.
RESULTS: In approximately 18 months, the San Francisco site screened
1,058 people of whom 869 (82%) completed a baseline interview. Three
hundred seven of those interviewed (35%) met eligibility criteria and 271
(88% of those eligible) enrolled in the trial. Thirty four percent of enrolled
participants reported learning about the study from advertisements, 33%
were referred by agency/service providers, 18% were referred by word of
mouth, 6% were referred by another study, and 5% learned about the study
from our outreach staff member. Demographically, 62% were categorized as
men who have sex with men, 20% as injection drug users, 13% as women,
and 5% as heterosexual men/non-IDU. Ethnic identity included, 53%
White, 28% African-American, 6% as Latino/a, and 13% Other. Eighty
percent of the sample were aged 30 –49, 10% percent aged 50-59, and 7%
aged 18-29.
LESSONS LEARNED: With a limited recruitment period and complex
inclusion criteria, we cast a wide recruitment net targeting a broad range
of potential participants throughout the Bay Area. This method yielded
a diverse sample. We used an assertive approach with multiple
methods, and oversampled women and people of color (historically
under served communities in HIV behavioral intervention trials).

HIV Seroconversion Following Non-Occupational Post-Exposure
Prophylaxis

Roland, ME; Krone, MR; Neilands, TB; Tapia, J; Coates, TJ; Hecht,
FR; Martin, JN
Univ. of California, San Francisco, San Francisco, CA

BACKGROUND/OBJECTIVES: Post-exposure prophylaxis (PEP)
with zidovudine (ZDV) following occupational exposure is estimated
to reduce HIV transmission by 81%. There are, however, no
effectiveness data for PEP in the non-occupational setting (e.g.,
following sexual or injection drug use [IDU] exposures). We describe
early seroconversions in 2 studies of non-occupational PEP.
METHODS: Subjects reported potential sexual or IDU exposure to
HIV in the prior 72 hours. In study #1, subjects were provided
antiretroviral medication (ARV) and 5 sessions of risk reduction
counseling (RRC). In study #2, subjects received ARV and were
randomized to 2 versus 5 RRC sessions. ARV consisted of 28 days of 2
nucleoside analogue reverse transcriptase inhibitors (ZDV + 3TC, D4T
+ 3TC or D4T + ddI), depending upon the source partner’s ARV
history. A protease inhibitor (PI) was used when the source reported a
recent detectable HIV RNA while on ARV. HIV antibody testing was
performed at baseline and weeks 12, 26 and 52 and behavioral
questionnaires at baseline and weeks 26 and 52.
RESULTS: Of the 891 subjects enrolled, 700 were evaluable at the
week 12 visit and 6 seroconversions (0.86%; 95% CI 0.32 to 1.8%)
were detected. Five seroconverters had undetectable HIV RNA in
stored baseline plasma; a low-level detectable result, expected to be
false positive, is being repeated in 1 seroconverter. Mean HIV RNA at
diagnosis was 160,753 (range 3,381 to > 500,000) copies/mL. Three
seroconverters had no resistance mutations in the seroconversion
plasma sample; testing is underway in the others. All seroconverters
presented for PEP following receptive anal intercourse (RAI); 3 had
known HIV-infected partners and 3 had partners of uncertain
serostatus. The median time to initiate ARV was 51.5 hours (range 14 to
72.5) following exposure. No PIs were prescribed. Three
seroconverters reported 100% ARV adherence, 1 reported fair and 2
reported poor adherence. Two subjects reported on-going high-risk
behavior after taking PEP (RAI in one and insertive anal intercourse +
receptive oral intercourse [ROI] in another); all reported high-risk
encounters in addition to the presenting exposure in the six months
preceding PEP (5 reported RAI; 1 reported ROI). Four seroconverters
were determined to have probably failed PEP, although pre-PEP
exposures may have been responsible for their seroconversions. The
remaining 2 seroconverters are possible PEP failures; they had
exposures after PEP initiation that may be the source of their infections.
Compared to non-seroconverters, seroconverters presented more
frequently with RAI exposures (100% vs. 50%; p = 0.03) and had a
trend toward longer time to ARV initiation (median 51.5 hours from
exposure vs. 32.5 hours; p=0.11).
CONCLUSIONS: As in the occupational setting, PEP is not 100%
effective following non-occupational exposures. Because HIV
exposures are less likely to be isolated than in the occupational setting,
and biological samples from exposure sources — necessary to confirm
transmission between individuals — are rarely available, the nonoccupational
setting presents unique challenges when trying to
determine the source of seroconversion and hence document PEP
failure. Since PEP is not 100% effective, the importance of primary
prevention must be reinforced.

A Statewide Web-based Evaluation System for HIV Prevention
Providers: Evaluating Local Interventions (ELI)

Livermore, SR1; Clark, LR2; Heusner, CM3; Webb, DS3; Truax, SR3;
Myrick, R4; Bernstein, JT5
1 Department of Health Services, Office of AIDS, Prevention
Research and Evaluation Section, Sacramento, CA; 2 Logic Concepts,
Inc., San Diego, CA; 3 California Department of Health Services,
Office of AIDS, Prevention Research and Evaluation Section,
Sacramento, CA; 4 University of California, Universitywide AIDS
Research Program, Office of Health Affairs, Oakland, CA; 5
University of California San Francisco, Center for AIDS Prevention
Studies, San Francisco, CA

ISSUE: In response to federal program evaluation requirements, the
California State Office of AIDS (OA) designed and implemented an
innovative web-based data collection system for its HIV prevention
providers.
SETTING: Publicly funded HIV prevention providers throughout
California.
PROJECT: The goal of the Evaluating Local Interventions (ELI)
system is for California’s HIV prevention providers to be able to
systematically collect and access client-based information critical to
effectively prevent HIV infection and evaluate their programs. The
process began by conducting needs assessments across the State in
collaboration with the University of California AIDS Research Program
to define core measures that target program implementation and risk
behavior. Data collection forms for various types of encounters were
developed in conjunction with the system and are divided into
intervention types: individual, group, outreach, prevention case
management and health communication. Providers collect information
using these forms and then enter data into the ELI system via the
Internet. ELI resides on a highly secured server and requires password
access. The system continues to evolve based on provider feedback.
Statewide training and technical assistance on the use of ELI and
evaluation were co-developed by the OA and the UCSF Center for AIDS
Prevention Studies.
RESULTS: Throughout Spring and Summer 2002, a minimum of two
individuals from each of the 61 local health jurisdictions (LHJ) in
California were trained on the use of ELI. On-going training is currently
provided every other month around the State. Statewide
implementation of ELI began July 1, 2002 and ELI generated reports
indicate that as of February 2003 there are 1,186 interventions defined
with 335,188 contacts recorded. A total of 1,060 users and 187
community-based organizations are associated with at least one of the
61 LHJs. This is the first time basic information regarding HIV
prevention services other than HIV counseling and testing has been
summarized on a statewide level.
LESSONS LEARNED: Community and LHJ participation in the
development of ELI was crucial to its successful launch in July 2002.
Developing a flexible system that can be updated to meet the specific
needs of providers has been an essential feature of the ELI system.
Making several of the forms available in the Spanish language was met
with enthusiasm by providers. Training evaluations have been very
positive and supportive of the ELI system, although suggestions have
been made to create specific trainings for different users and levels of
data/computer experience, i.e, Basic ELI training and Advanced ELI
training. Feedback has also suggested that greater emphasis would be
useful on the reports generated from ELI combined with specific
examples of how the data could be used for evaluating programs.
Accessing the ELI database via the OA website has enabled users to
obtain up-to-date guidance, answers to frequently asked questions and
general evaluation information.

Community Collaborative Prevention Evaluation Research in
California

Myrick, RK1; Binson, D2; Brown, NL3; Conner, R4; Shillington,
AM5; Aoki, B1; Truax, S6; Rasmussen, H6; Lemp, G1; Johnson, D6
1 Universitywide AIDS Research Program/University of CA/Office of
the President, Oakland, CA; 2 University of California San Francisco,
Center for AIDS Prevention Studies, San Francisco, CA; 3 Palo Alto
Medical Foundation Research Institute, Palo Alto, CA; 4 University
of California Irvine, Irvine, CA; 5 San Diego State University, San
Diego, CA; 6 California State Office of AIDS, Sacramento, CA

ISSUE: There is a significant need among HIV prevention service
providers for increased capacity for outcome evaluations of
interventions serving high risk populations who continue to be heavily
impacted by the epidemic. This group oral session will address this
issue and include presentations from panelists working on community
collaborative outcome evaluation projects.
SETTING: Academic and community-based organizations serving
women, youth, communities of color, and MSM populations in
California.
PROJECT: The California Prevention Evaluation Initiative (CPEI) – a
community collaborative research funding partnership between the
Universitywide AIDS Research Program, University of California,
Office of the President, and the California State Office of AIDS –
recently implemented a unique research opportunity that provides
funding for outcome evaluation of interventions serving women, youth,
communities of color, and MSM populations in CA. A critical
component of these projects is the development of evaluation and
intervention capacity for university and community organizations
serving these high risk populations.
RESULTS: Four projects were funded through this initiative. Projects
include evaluations and capacity development for small group
workshops for Latino gay & bisexual men and IDU women, an
evaluation of drop-in centers for youth, and a comparison of individual
counseling and testing for gay men in a bathhouse setting versus people
of color in a clinic setting. This panel will include presentations from
investigators from these projects, and will focus on the following topics:
effective processes for developing collaborative relationships among
research and community partners; successful strategies for building
evaluation and intervention capacity in organizations serving the above
populations; and the effectiveness and/or acceptability of the
interventions for populations served.
LESSONS LEARNED: Community-based research provides an
opportunity for academic and prevention service providers to work
together to build collaborative relationships in support of evaluation
and evidence-based intervention service delivery. Such relationships
ultimately provide critical information on intervention effectiveness,
and, as importantly, provide much needed opportunities for the
development of long term capacity for the delivery of prevention and
evaluation services for populations most heavily impacted by the
epidemic.

Meta-analysis of HIV Prevention Interventions in African-
American Heterosexuals

Darbes, LA1; Crepaz, N2; Lyles, C2; Kennedy, G3; Zohrabyan, L4;
Peersman, G5; Rutherford, GW3
1 UCSF—Center for AIDS Prevention Studies, San Francisco, CA; 2
Behavioral Intervention Research Branch—CDC, Atlanta, GA; 3
UCSF—AIDS Research Institute, San Francisco, CA; 4 Northrop
Grumman, Atlanta, GA; 5 Global AIDS Program—CDC, Atlanta, GA

BACKGROUND: Recent studies have shown a substantial increase in
HIV infections among racial/ethnic minorities in the U.S. Compared to
otehr racial groups in the U.S., African Americans have the highest
incidence, prevalence and mortality due to HIV. We conducted a
systematic review in 2001 of HIV prevention interventions in U.S.
minority populations conducted between 1988 and 2000. The search
strategy was updated through 2002 and a subsequent meta-analysis was
conducted of a subset of trials that addressed the issue of heterosexual
risk among African Americans.
METHODS: We conducted comprehensive and systematic searches
for both published and unpublished studies. For the meta-analysis our
inclusion criteria required that studies were randomized or controlled
clinical trials, and that the sample population be comprised of either
100% African-American participants, over 80% African-American
participants, or results for African-American participants could be
examined separately. Outcomes were selected hierarchically such that
unprotected sex was the primary outcome and condom use was the
secondary outcome measure. For each study, we calculated odds ratio
(OR) and variance for determining weight. A random effects model was
used to combine weighted ORs. ORs greater than 1 indicate that
interventions were effective in reducing sexual risk-taking.
RESULTS: We identified 78 potentially relevant studies. Of those, 51
were excluded for not meeting our inclusion or methodological criteria
(e.g., not reporting results separately for African-American
participants). Of the remaining 27, 21 trials examined adult heterosexual
risk and 6 examined adolescents. Results from the 24 trials examined to
date (of over 7,000 participants) demonstrate that, overall, behavioral
interventions had a positive and significant impact on reducing HIV risk
behavior in persons with heterosexual risk. However, altering the risk
behavior of persons whose risk stems from injection drug use appears to
be more of a challenge.
Comparison # of studies Odds Ratio 95% CI
All adult heterosexual studies 24 1.43 1.21-1.69
Drug Users 7 1.25 0.86-1.80
Heterosexuals 17 1.52 1.26-1.83
Heterosexual adolescents 5 1.93 1.07-3.47
CONCLUSIONS: Overall, the results demonstrated that behavioral
interventions can positively impact HIV risk behavior in heterosexual
African Americans. Alternative strategies may be needed to best reach
injection drug users. These data can be useful in the design and
implementation of programs aimed towards preventing HIV infection in
the African-American community.

Spanish Language Initiative: Building a Bridge to the HIV
Prevention Spanish-Speaking World

Arjona, M
Center for AIDS Prevention Studie (CAPS), University of California
(UCSF), San Francisco, CA

ISSUE: Language barriers are factors for health disparities. HIV
prevention sciences information, technical assistance, and materials for
Spanish-speaking populations continue to be limited, as well as the
access to existing resources by those who serve this population in the
United States. 1990 US Census reported that 54.4% of the total of Non-
English-only speakers in the US are Spanish speakers, from which 38%
reported “Not Well” and “Not alt All” ability to Speak English. US
Census 2000 indicates that Latinos in California represent 32% of
state’s total population (11 million), and 44% of the Mexican
immigrants in the U.S. are in California (3.8 million).
SETTING: Spanish language project initiated at the Center for AIDS
Prevention Studies (CAPS) of the University of California in San
Francisco, CA as a response to domestic and international stakeholders’
inquires. CAPS has a history of providing TA, disseminating sciences,
and promoting collaborative research between researchers, CBOs, and
health departments.
PROJECT: CAPS Spanish Language Initiative (SLI) aims to facilitate
access to HIV prevention information and research for bilingual English-
Spanish, monolingual Spanish and English speakers working for Spanishspeaking
populations. The three mayor components for the SLI are
Technical Assistance (TA), Science Dissemination, and Community Public
Relations. Some of the TA consists of a) access to information/materials,
evaluation tools, model programs, and curricula in Spanish; b) assessment
for culturally and linguistically appropriate materials, and language
consultations; c) linkages to resources in Spanish for training, capacity
building, and TA. Science Dissemination takes place mainly through CAPS
Website. Community Public Relations consist of outreach to community
stakeholders, promotion of collaborative research between CBOs and
academics, linkages between same-interest groups or individuals, and an
electronic mail distribution list.
RESULTS: Overall, the SLI has contributed to increase awareness on
immigrant and Latino HIV/AIDS prevention issues and functioned as a
liaison for CAPS. Developed Spanish CAPS Website section:
caps.ucsf.edu/uploads/espanol/index.html SLI Implemented a peer review
process with national and international stakeholders on Spanish CAPS
Website’s contents and related language issues. Provided free TA in Spanish
to local, domestic and international requesters. Collaborated with the
California State Office of AIDS (CSOA) through the California Technical
Assistance Program (CTAP) to facilitate TA, locate CTAP resources in
Spanish, and include Spanish formats for statewide data collection forms of
HIV prevention interventions for CSOA-ELI system.
LESSONS LEARNED: 1) Researchers, health departments, and
service providers require tools to work with Spanish-speaking
populations. 2) Bilingual personnel (especially front-line staff) require
bilingual administrative/training materials. 3) Existing HIV prevention
materials in Spanish are mainly oriented to consumers. 4) The SLI can be
an advocacy tool for working and serving Spanish-speaking
populations.

Working Together: A Guide to Collaborative Research in HIV
Prevention

Goldstein, E; DeCarlo, P; Freedman, B; Faigeles, B; Grinstead, O;
Wohlfeiler, D; Binson, D; Woods, B
Center for AIDS Prevention Studies (CAPS), San Francisco, CA

ISSUE: In order for research to make a difference, it must be used.
That means that research conducted must be applicable to the world of
service and CBOs must know how to incorporate research in their
programs. Unfortunately, HIV prevention frequently doesn’t work
that way. Researchers and service providers have different cultures,
making collaboration a cross-cultural experience that requires time and
training to achieve.
SETTING: For the past 15 years, CAPS has conducted over 20
collaborative research projects linking CBO staff and university-based
researchers.
PROJECT: Based on our research and experience, we created a manual
for CBOs and researchers on how to best work collaboratively.
“Working Together: A Guide to Collaborative Research in HIV
Prevention” details best practices for each stage of a collaborative
research project, from finding a collaborative partner, to developing a
research question, to collecting and analyzing data, to incorporating
findings, to disseminating results. The manual is available online at

http://caps.ucsf.edu/uploads/collaboration.

RESULTS: Collaboration changes the nature of questions asked and
the methods by which those questions are asked. Our manual gives
seven best practices to ensure the success of collaborative research
projects: 1) get funding, 2) specify roles, 3) be committed, 4) provide
training, 5) meet regularly, 6) be flexible and 7) start early. It also offers
case studies of successful collaborative projects.
LESSONS LEARNED: While collaboration is not for everyone in
every situation, it can change the way researchers and service
providers work, and make HIV prevention more effective.

Trends in Sexual Risk Taking Among Urban Young Men Who
Have Sex with Men

Peterson, J1; Seal, D2; Kelly, J2; Choi, K3; Miller, R4; Stokes, J4;
Remafedi, G5; O’Donnell, L6; Stueve, A6; Ford, W7; Clark, L8;
Guenther-Grey, C9; Wright-Fofanah, S9; Lin, L9; Sumartojo, E9
1 Georgia State University, Atlanta, GA; 2 Center for AIDS
Intervention Research, Medical College of Wisconsin, Milwaukee,
WI; 3 Center for AIDS Prevention Research, San Francisco, CA; 4
University of Illinois at Chicago, Chicago, IL; 5 Youth and AIDS
Project, University of Minnesota, Minneapolis, MN; 6 Education
Development Center, Inc, Newton, MA; 7 Los Angeles County Dept
of Health Svcs, Los Angeles, CA; 8 University of Alabama,
Birmingham, AL; 9 Centers for Disease Control and Prevention,
Atlanta, GA

BACKGROUND/OBJECTIVES: To examine trends in sexual risk
taking among young men who have sex with men (YMSM) in six U.S.
cities from 1999-2002.
METHODS: Time-space sampling was used to recruit representative
samples of YMSM (ages 15-25 years) from 6 comparison sites in an
HIV intervention trial. Surveys of YMSM were conducted from May to
September of four years: 1999 (N=1260); 2000 (N=1393), 2001
(N=1424); 2002 (N=1451). Two sites recruited Latinos (NYC/Jackson
Heights; CA/San Gabriel Valley); one recruited African Americans
(Atlanta); one recruited Asians/Pacific Islanders (API, San Diego), and
two recruited YMSM regardless of race/ethnicity (Detroit;
Minneapolis). YMSM completed structured interviews about sexual
behavior, including unprotected anal intercourse (UAI) in the past 3
months with male partners. For each site, the prevalence of UAI in 1999
was compared to 2002, using a two-tailed test with a .05 level of
statistical significance.
RESULTS: Combining data from the 6 sites, overall levels of UAI
among urban YMSM decreased over time (1999=32.0%; 2000=29.6%;
2001=30.3%; 2002=28.5%). Across sites, there were notable
differences. At both of the Latino sites, reports of UAI markedly
decreased from 1999 to 2002. In Minneapolis, rates of UAI increased
over time, but the trend was not statistically significant. Changes in
UAI were less consistent elsewhere.
Prevalence [%(N)] of Unprotected Anal Intercourse in 6 Sites
Site 1999 2000 2001 2002 P Value
(T4-T1)
Latino: NYC/
Jackson Heights 31.0 (255) 25.7 (253) 20.4 (255)13.9
(252) <.001
Latino: CA/
San Gabriel Valley 34.4 (106) 35.1 (268) 30.8 (223)24.7
(267) <.01
(T4-T2)
African-American:
Atlanta 27.7 (256) 27.5 (255) 24.0 (267)24.2
(262) NS
API: San Diego 34.7 (124) 33.3 (112) 42.7 (143)34.7
(137) NS
All Ethnicity:
Detroit 30.6 (264) 43.4 (254) 38.1 (289)35.3
(281) NS
All Ethnicity:
Minneapolis 26.7 (255) 27.9 (251) 30.3 (247)33.6
(252) <.10
CONCLUSIONS: Among YMSM interviewed between 1999-2002,
there were notable differences in UAI by site and race/ethnicity. These
differences demonstrate the importance of local behavioral surveillance
and underscore the continued need for community-based prevention
efforts for young MSM.

Effective Capacity Building
Goldstein, E1; Vernon, K1; Lew, S2
1 Center for AIDS Prevention Studies, UCSF, San Francisco, CA; 2
CompassPoint Non-profit Services, San Francisco, CA

ISSUE: In the past few years, there has been much focus on and
investment in Capacity Building for CBOs to strengthen their ability to
provide services. Guidelines for effective capacity building work are
critical.
SETTING: This workshop addresses Capacity Building as practiced in
CBOs nationally. The discussion is primarily based on the external
evaluation of a three-year Capacity Building demonstration project in
San Francisco, CA. It is augmented by a literature search and one-year
analysis of CDC’s capacity building activities.
PROJECT: CapacityLEAP is funded by an initiative through the Office
of Minority Health to improve and support HIV prevention and care
agencies based in people of color communities. The 7 funded agencies
were matched with a Lead Consultant and awarded hours of
consultation; provided an annual budget with which to “purchase”
capacity (i.e. computers, strategic planning retreat costs), and
workshop credits for staff training. The project began with an extensive
assessment in each agency, followed by the development of a tailored
workplan. Each of the agencies had unique needs and circumstances, yet
common themes appeared in the needs assessments and the delivery of
capacity building. These themes reinforce the assessment of CDC CBA
delivery system as well as the literature on capacity building.
RESULTS: Strong relationships, based on the consultant respecting the
culture of the agency, facilitated effective uptake of capacity building
assistance. Buy-in from the board, the executive director, and the staff,
and communication between these three constituencies, was necessary
for the agency to become proficient in using new skills. Capacities built
included changes in the organization’s culture (becoming more
professional or help-seeking) and changes in the organization’s
functions (human resource, information technology, fiscal
accountability). In some agencies, the capacity building prevented
potential disruption of services due to organizational transitions.
LESSONS LEARNED: Capacity building is a relationship-based
activity, rather than just a menu of trainings or skill-sets to be delivered.
Staff or consultant turnover made capacity building more difficult.
Capacity building is an intervention with individuals and systems. It is
more than a set of skills for a few people in the system. Developing a
self-reflective culture of learning can improve our programs.

Pre-incarceration Risk Behavior among Incarcerated Young Men
Margolis, AD1; MacGowan, RJ1; Sosman, JM2; Flanigan, TP3;
Grinstead, O4; Askew, J5; Dey, A1; Project START Study Group
1 Centers for Disease Control and Prevention, Atlanta, GA; 2
University of Wisconsin Medical School, Madison, WI; 3 Department
of Medicine, The Miriam Hospital and Brown Medical School,
Providence, RI; 4 Center for AIDS Prevention Studies, University of
California, San Francisco, San Francisco, CA; 5 Jackson State
University, Jackson, MS

BACKGROUND: Approximately 2 million people in the United States
are incarcerated. Many people entering correctional facilities have a
history of substance use and risky sexual behavior, in addition to high
rates of HIV and STDs. Nine out of ten inmates are eventually released
and return to the community from which they came.
OBJECTIVES: (1) describe pre-incarceration sexual behavior and
substance use of incarcerated young men; and (2) identify correlates of
unprotected vaginal sex.
METHODS: Men, 18 to 29 years of age, (N=519) were recruited and
interviewed while incarcerated in state prisons located in California,
Mississippi, Rhode Island, and Wisconsin. Data were obtained from
each participant on risk behaviors that had occurred before this
incarceration. Logistic regression was used to identify correlates of
unprotected vaginal sex during the 3 months before this incarceration.
RESULTS: During the three months prior to incarceration, 71% of the
men had multiple (>1) sexual partners, 66% had sex with a partner they
perceived as risky (history of IDU, crack cocaine use, exchanging sex for
drugs/money, multiple partners, STD, HIV+), 82% had a main female
partner, 70% had a casual female partner, more than half (56%) of the
men had both main and casual female sexual partners, and most (85%)
had unprotected vaginal intercourse. Of the men, 72% indicated heavy
alcohol use (drinking >=5 drinks per day), and 34% drank heavily at
least 3 times per week during the 3 month reporting period. During the
3 months prior to incarceration, 79% used marijuana, and 24% ecstasy
or powder cocaine. In addition, 8% of the men had injected drugs during
their lifetime. In logistic regression analyses, unprotected vaginal sex
was associated with heavy drinking (OR, 1.74, 95% CI 1.01-3.00),
having a risky sex partner (OR, 2.39, 95% CI 1.42-4.00) and using
marijuana (OR, 1.89, 95% CI 1.07-3.36).
CONCLUSIONS: The majority of the participants engaged in
behaviors that could result in HIV or STD transmission or acquisition.
Effective HIV and STD prevention programs should be provided to
incarcerated men, particularly to those with a history of substance
abuse.

Mapping Local Geography of HIV Late Presenters in a Northern
California County AIDS Program

Levy, V1; Chen, S2; Page-Shafer, K3; Prentiss, D4; Katzenstein,
DA1; Israelski, DM1
1 Stanford University, Stanford, CA; 2 SF Dept. Public Health, San
Francisco, CA; 3 Center for AIDS Prevention Studies, University of
California, San Francisco, CA; 4 San Mateo County Health Center,
San Mateo, CA

BACKGROUND/OBJECTIVES: San Mateo, California, a county of
710,000 persons, has seen an increase in persons with self reported
Hispanic ethnicity on Census surveys from 12.5% in 1980 to 21.9% in
2000. In the San Mateo County AIDS Program (SMCAP), foreign born
persons, mainly of Mexican and Central American origin, comprise 19%
(n=76) of those served (n=399). Between November 1999-March 2002,
foreign born patients had twice the odds of AIDS defining opportunistic
infections (OIs.) Among all hospitalized HIV patients in San Mateo
County Hospital (n=56) during this time interval, ten of fifty six (18%)
were newly diagnosed with HIV during their inpatient stay. Among
these newly diagnosed, 8 of 10 were foreign born. We sought to look at
the local geography of our “delayed presenters-” persons with
diagnosed OIs and our county prevention efforts via mobile van and
clinic anonymous HIV testing services.
METHODS: OIs were identified through a retrospective review of
inpatient medical records using ICD-9 codes for HIV or OIs and a
clinical outpatient database of currently active HIV patients from three
county clinics. Self reported residence zip code in medical records at
time of OI diagnosis was used. Anonymous HIV tester’s residence zip
codes were self reported during HIV pre-test counseling. Using the
ArcView geographic information system (GIS), we mapped by zip
codes: HIV OI prevalence in the SMCAP from 11/99-3/02 (n=79) and
Anonymous HIV Tests conducted January 01-December 01 (n=4,209)
in San Mateo County.
RESULTS: Map 1 shows HIV OI prevalence (n=79) November 1999
to March 2002 in the SMCAP mapped by self reported zip code of
residence. Map 2 shows anonymous HIV tests (n=4,209) conducted
January 2001 to December 2001 in San Mateo County mapped by self
reported zip code of residence.
Of the 4,209 HIV tests done, 27 (0.6%) tested positive. Hispanics
represented 32.9% of those tested, African Americans 27.5% and non-
Hispanic Whites 27.2%.
CONCLUSIONS: The distribution of anonymous HIV testers
overlaps geographic zip code areas of delayed presenters fairly closely.
However, Hispanic immigrant populations, due to language, legal,
sociocultural or other barriers, may not be accessing available
prevention and testing services. An HIV partner notification system,
grounded in social network concepts, may better inform prevention
efforts directed at marginalized populations.

Last modified: November 2, 2012