NOTE: This study has ended.
During the first decade of the AIDS epidemic, it was well established that HIV infection was highly prevalent among sexually active white homosexual men. Fifteen years after the first cases appeared, African-American gay and bisexual men in the US are disproportionately affected by HIV. Many Black gay men are at high risk for HIV, yet few programs exist for them, and even fewer have been evaluated for effectiveness.
The African-American Men’s Health Study represents the first published attempt to develop and evaluate the impact of a culturally appropriate, community-based, HIV risk reduction intervention designed to change high-risk sexual behaviors among African-American homosexual and bisexual men in the San Francisco Bay area. The underlying theory for this social-cognitive intervention was derived from the AIDS Risk Reduction Model (ARRM).
From November 1989 until June 1991, The African-American Men’s Health Study recruited 318 self-identified gay and bisexual African-American men from bars, bathhouses, erotic bookstores, gay African-American organizations, street outreach, advertisements in mainstream gay newspapers, African-American newspapers, and personal referrals from other study participants or from their friends or acquaintances who had heard about the study. The average age of the men recruited was 31 with the majority being single; 52% of the men reported engaging in unprotected anal intercourse during the past 6 months; 38% had engaged in sex for pay sometime in their life; and 25% had not been tested for HIV.
These men were randomized into three groups: a triple session intervention, a single session intervention and a wait-list control. Of the three groups, the triple session intervention seemed to be the most effective.
The intervention consisted of three 3-hour weekly group meetings. All training materials, video tapes, games, and role plays were extensively pilot tested for their accuracy and cultural relevance for African-American gay and bisexual men. For example, the videos selected only depicted African-American men, and expressed, in culturally appropriate language, issues and experiences related to same-sex attitudes and behaviors.
You can view and download the curriculum for the African-American Men’s Health Study.
The three sessions were grouped around the following themes: Self-identity and development of social support Initially, the facilitators attempted to reinforce each participant’s self-identity as a member of both a racial and sexual minority group, to promote a feeling of self-pride in this dual minority status, and to help each participant understand the possible consequences of poor self-identity for risk-taking behaviors. Participants first viewed segments of the video “Tongues Untied” about African-American homosexual men. Then they discussed their negative and positive experiences associated with being members of both racial and sexual minorities, and perceptions of their HIV risks as sexual minorities.
AIDS risk education
The participants engaged in two activities designed to improve their knowledge of risk reduction information and effective use of condoms. Participants were divided into teams to play the “AIDS Jeopardy Game” which demonstrated their knowledge of HIV risk activities. After the game, facilitators discussed incorrect answers, presented information about HIV risks associated with sexual transmission, drug transmission, the importance of HIV antibody testing, and responded to questions from the participants. During the “Condom Games”, participants examined their positive and negative emotions about low-risk activities.
The next intervention activities taught assertiveness for negotiating low-risk sexual behaviors in two different contexts; initiating low-risk activities or refusing high-risk activities with a current sexual partner; and with a potentially new sexual partner. Following instructions by facilitators and practice demonstrations, participants formed dyads to engage in role-plays similar but not identical to those rehearsed.
In an effort to strengthen commitment to risk reduction, the last activity allowed participants to share strategies they had used for risk reduction and to make a verbal commitment before the group to change their risk behaviors.
The men who participated in the program greatly increased their safer sex behaviors. Rates of unprotected anal intercourse fell from 45% to 20% at an 18-month follow-up evaluation. Comparatively, men who attended only one session showed only slight rates of behavior change, and men who attended no sessions showed no change in risky sexual behavior. An article describing the results in detail was published in the journal AIDS, March 1996 volume 10, number 3, pages 319-325.
Last modified: October 22, 2012