HIV Risk Behavior of Adult Minority Heterosexual Men in New York City

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The proposed study will focus on an essential but neglected area of HIV prevention research: sexual behavior and determinants of HIV risk among HIV seropositive adult African American and Latino men who have sex with women (MSW) in urban settings. Heterosexual transmission of HIV has steadily increased in recent years and now accounts for over one-third of all new HIV/AIDS diagnoses in the U.S.—and 80% among women. Minority women are especially vulnerable to sexually acquired HIV. Social and cultural norms that reinforce gender inequalities often prevent minority women from enacting safe sex practices with male partners. This has led researchers to focus on women's sexual risk behavior and the development of HIV prevention programs targeted to women, often to the exclusion of men. However, male condom use remains under the control of men, and culturally sanctioned social norms afford men greater power with respect to sexual behavior and decision-making. Despite the central role played by HIV positive adult minority men in the heterosexual transmission of HIV, little is known about their sexual practices, and the psychosocial, contextual, and cultural factors underlying men’s risk behavior. The proposed 2-year study will help fill this gap using a mixed methods design involving 324 HIV positive adult MSW recruited from primary care settings in Harlem and South Bronx in New York City. This research will be guided by an integrated conceptual framework of MSW sexual risk behavior, synthesized from current health behavior theory and refined through qualitative interviews. A structured quantitative questionnaire will be administered to participants using audio computer assisted self-interview (ACASI) techniques. The questionnaire will include items documenting the range, variation, patterns, and networks of adult men’s heterosexual behavior, and related determinants. Structural equation modeling will be used to specify and validate an empirical model of HIV positive men’s sexual risk that will inform HIV prevention efforts targeting secondary heterosexual transmission of HIV to women in high prevalence communities.