HIV Prevention for High Risk African American Young Men

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DESCRIPTION (provided by applicant): This application is being submitted in response to the NIH's Program Announcement entitled, "Health Disparities in HIV/AIDS: Focus on African Americans" (PA-07-289), which recognizes that "African Americans [represent] a group that has experienced exceptionally high rates of new HIV infections and worse survival rates than other ethnic/racial groups in this country" A particular focus of this program announcement is the development of "theoretically based, developmentally appropriate, and culturally sensitive HIV preventive interventions targeting individual, social, and environmental factors for vulnerable African-American populations (e.g., men who have sex with men (MSM), sex workers, youth)." The specific aims of this R21 application are to: 1) adapt an effective, evidence-based intervention called Project AIM (Adult Identity Mentoring) so that it is developmentally appropriate and culturally relevant for use with African-American (AA) young men who have sex with men (YMSM) in Los Angeles; 2) pilot test the feasibility and acceptability of the new intervention that we will call Young Men's AIM (YM-AIM); and 3) identify barriers and facilitators with respect to implementing YM-AIM in community settings. Data from our own Healthy Young Men's (HYM) Study provides strong evidence that AAYMSM are significantly more likely to have experienced racial discrimination and to report significantly higher levels of internalized homophobia than Latino and Caucasian YMSM. AAYMSM are also significantly more likely to experience various forms of violence and victimization, including homophobia, when growing up, sexual/social discrimination based on race, and institutional racism relative to Caucasian and Latino YMSM. These experiences of racism, homophobia, and violence were in turn found to be significantly associated with illicit drug use, alcohol misuse, and involvement in HIV sexual risk behaviors. These and other findings emphasize the need for prevention interventions that are tailored to meet the unique needs and risk profiles of AAYMSM. In this study, we are proposing to adapt an existing HIV prevention intervention called Project AIM for use with 18-24 year old AAYMSM. Project AIM is an effective, evidence-based intervention with demonstrated short- and long-term increases in sexual abstinence and reductions in sexual activity among African-American adolescent males. Drawing upon the Theory of Possible Selves, Project AIM seeks to steer adolescents away from risky behavioral choices by offering alternative avenues to define themselves as adults. Findings from our HYM study, including findings from mixed-methods research conducted with a cohort of 126 AAYMSM (ages 18 to 24 years), will inform the adaptation of Project AIM. We will also engage and solicit input from AAYMSM and local youth service providers. Once adapted, the new intervention (YM-AIM) will be pilot tested to determine its feasibility and acceptability and to identify barriers and facilitators with respect to implementing YM-AIM in community settings. PUBLIC HEALTH RELEVANCE Rates of HIV infections continue to rise among African American young men who have sex with men, and yet it remains the case that few prevention interventions have been developed specifically for this population. We are proposing to adapt and pilot test the Adolescent Identity Mentoring (AIM) intervention, an evidence-based prevention intervention that has previously been found to be effective with younger high-risk African American youth.