HIV Education for African American Men

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 DESCRIPTION (provided by applicant): One in 16 Black men will be diagnosed with HIV in his lifetime as compared to 1 in 102 White men. Approximately 20% of all new HIV cases among African American men are due to heterosexual transmission. Despite this, Black men who have sex with women (MSW) have received very little empirical attention. Traditional gender roles and power inequalities tend to give men greater control over sexual decision-making in African American relationships. However, Black men do not routinely use condoms, one of the most effective HIV prevention methods beyond abstinence, during sex with women. These findings suggest that the failure to target heterosexually active African American men in HIV prevention efforts is a missed opportunity. A key barrier to male condom use is reduced sexual pleasure. The female condom (FC) is an alternative HIV protection method that may overcome this barrier. Research shows that Black women respond well to FC education, but gender norms may impede their efforts to introduce FCs to male partners. One way to overcome this roadblock is to provide FC training directly to men. Indeed, studies have shown that men can learn FC skills, will help female partners use FC, and report fewer unprotected sex partners after receiving FC and male condom training. In addition, men endorse several benefits to FC use, including STI protection and natural feel. Importantly, some men prefer FCs because they provide greater sexual sensation than male condoms. To harness the potential of FC training for Black MSW, we intend to develop e-focus, a computer-based HIV behavioral intervention for heterosexually active African American men that includes training in both male and female condom use. e-focus will web-enable the core components of Focus on the Future (FOF), the only best-evidence HIV behavioral intervention for high-risk Black MSW. FOF is a one-hour intervention that addresses the correct and consistent use of male condoms and lubricant, condom negotiation, and the importance of men protecting their future. The main message of FOF is that there are many types of condoms and lubricants and men should experiment to find the choice that make sex feel best. By providing FC as an additional, and sometimes preferred, choice, e-focus aims to lessen the influence of decreased sexual pleasure and other condom barriers on HIV prevention. Another obstacle to Black MSW's HIV risk reduction behavior is belief in a traditional masculine ideology, which emphasizes male sexual prowess, female subordination, and heterosexuality. Black men who espouse these beliefs are more likely to engage in sexual risk behavior. To combat this, e-focus will include a discussion of masculine identity and will provide methods to reframe potentially dangerous masculine beliefs into healthier sexual and relationship behaviors. Phase I prototype development will be informed by formative research with target end-users and African American women, as well as input from our expert consultants. The completed prototype will undergo usability testing and a prototype review with African American MSW seeking services at an HIV/STI service provider.