HIV Education for African American Men

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PROJECT SUMMARY/ABSTRACT One in 16 Black men will be diagnosed with HIV in his lifetime as compared to 1 in 102 White men. Nearly 15% of these 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. This is a missed public health opportunity. First, Black men do not routinely use condoms, one of the most effective ways to prevent the sexual transmission of HIV, indicating the potential for substantial behavioral impact. And second, 80% of new HIV infections in African American women are due to sex with men. The intra-racial nature of sexual networks suggests most of these women are infected by Black men. Thus, reducing HIV incidence among Black men should concomitantly reduce HIV disparities among African American women. The female condom (FC) is an alternative HIV protection method that may overcome a key barrier to male condom use: reduced sexual pleasure. 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 is to provide FC training directly to men. Indeed, preliminary research has shown that men report fewer unprotected sex partners after receiving both female and male condom training. In addition, men endorse several benefits to FC use, including that they provide greater sexual sensation than male condoms. To harness the potential of FCs for Black MSW, we intend to develop Focus, a computer-based HIV behavioral intervention for heterosexually active African American men that provides training in male and female condom use. Focus will computer-enable the core components of Focus on the Future (FOF), the only best-evidence HIV behavioral intervention for Black MSW. The one-hour FOF session addresses the correct and consistent use of male condoms and lubricants, condom negotiation, and the importance of protecting one's future. FOF's main message is that there are many types of condoms and lubricants and men should experiment to find the ones that make sex feel best. By providing FCs as an additional option, Focus aims to lessen the impact of a major barrier to condom uptake: reduced sexual pleasure. Another barrier to Black MSW's HIV risk reduction behavior is belief in a traditional masculine ideology. Black men who espouse these views are more likely to engage in sexual risk behavior. To counteract this, Focus will provide methods to reframe potentially dangerous masculine beliefs into healthier sexual and relationship behaviors. The results of Phase I strongly support the feasibility and potential effectiveness of Focus, far exceeding the established benchmarks. In Phase II, we will complete development of Focus and test its effectiveness in a randomized controlled trial with 120 African American MSW. Participants will be randomly assigned to either receive the Focus program or the attention control materials. Before, and at two points after random assignment, condom use behaviors as well as condom skills, attitudes, and partner negotiation will be assessed.