Multilevel HIV Prevention Intervention for Young African American Men

描述（由申请人提供）：艾滋病毒的流行率和发病率在18-29岁的年轻黑人男男性行为者（YBMSM）中达到了灾难性的水平。该项目的目标是确定一种多层次的、基于理论的干预措施的有效性，这种干预措施被称为联合黑色元素（UBE），它可以减少男同性恋者的性风险行为，并增加艾滋病毒检测的频率。尽管基于mpowerproject（一种具有成本效益的艾滋病预防干预措施，已被证明在降低年轻男同性恋者无保护性行为率方面是有效的），但UBE已经广泛地适应了男同性恋者生活的社会经济、文化和社会背景。通过发展一个被授权的、动员起来的男同性恋者社区，UBE围绕艾滋病毒预防创造了积极的社会规范，并在各种社会网络中传播。在疾病预防控制中心的资助下，我们开始在德克萨斯州的达拉斯和休斯顿启动并开始测试UBE的功效；达拉斯被随机分配到干预组。之所以选择大城市，是因为那里是大多数YBMSM居住的地方，在这样的环境中测试社区动员方法对于考虑如何将其转化为实践至关重要。由于社区能力问题，全面实施UBE的时间比预期的要长，但UBE现在已经完全实施，并正在进入达拉斯YBMSM的各种社交网络。支持干预和基线评估的疾病预防控制中心资金已经结束，德克萨斯州卫生部现在正在与我们合作的一个地方组织资助UBE。在拟议的混合方法项目中，我们有一个非常好的机会来研究这种干预措施的影响，而不必启动或支付干预措施的成本。因此，这个混合方法项目的目的是：1)分析公共卫生数据，并使用基于场所的抽样对达拉斯和休斯顿的YBMSM进行3次额外的年度横断面调查，以确定UBE在以下方面的功效：(a)减少无保护的肛交；(b)增加最近的艾滋病毒检测；(c)修改可能与降低艾滋病毒风险有因果关系的社会心理中介变量；(d)与积极的心理健康和福祉有关的不断变化的社会心理因素；2)通过检查社会心理中介变量、性危险行为和艾滋病毒检测何时发生变化，以及性危险行为和检测的变化是否持续改善、保持不变或随时间减少，确定在实施UBE期间社区变化是如何发生的；3)探讨UBE如何渗透到达拉斯不同的YBMSM亚社区，以及这种多层次干预如何影响与风险行为和检测相关的个人、人际和社会层面因素。在全面实施干预措施时，我们将使用人种学跟踪纵向队列。4)通过管理和分析来自调查的定量数据和来自访谈的定性数据，检验生物医学艾滋病预防方法融入UBE的可能性。

DESCRIPTION (provided by applicant): HIV prevalence and incidence rates have reached catastrophic levels among young black men who have sex with men (YBMSM), ages 18-29. The goal of this project is to determine the efficacy of a multilevel, theory- based intervention, calld United Black Element (UBE), in reducing YBMSM's sexual risk behavior and increasing the frequency of HIV testing. Although based on the Mpowerment Project, a cost-effective HIV prevention intervention that has been shown to be efficacious in reducing the rate of unprotected sex among young MSM, UBE has been extensively adapted to the socioeconomic, cultural, and social context of YBMSM's lives. Through the development of an empowered, mobilized YBMSM community, UBE creates positive social norms around HIV prevention that are diffused throughout diverse social networks. We began work to launch and begin testing the efficacy of UBE in Dallas and Houston, TX with CDC funding; Dallas was randomized to the intervention condition. Large cities were chosen since that is where the majority of YBMSM reside, and testing a community mobilization approach in such a setting is critical in considering how to translate it to practice. It took longer than anticipated to fully implement UBE because of community capacity issues, but UBE is now fully implemented and is reaching into diverse social networks of Dallas YBMSM. The CDC funding that supported the intervention and baseline assessments has ended, and the Texas State Health Department is now funding UBE at a local organization with which we are collaborating. In the proposed mixed methods project, we have an extraordinary opportunity to study the impact of this intervention without having to start up or cover the costs of the intervention. Thus, the aims of this mixed methods project are to: 1) Analyze public health data and conduct 3 additional annual cross-sectional surveys of YBMSM in Dallas and Houston using venue-based sampling to determine the efficacy of UBE in: (a) reducing unprotected anal sex; (b) increasing recent HIV testing; (c) modifying psychosocial mediating variables that may be causally related to HIV risk reduction; and (d) changing psychosocial factors related to positive mental health and well-being; 2) Determine how community changes occur during implementation of UBE by examining when changes in the psychosocial mediating variables, sexual risk behavior and HIV testing take place and if changes in sexual risk behavior and testing continue to improve, remain the same, or decrease over time; 3) Explore how UBE penetrates diverse YBMSM subcommunities in Dallas, and how this multilevel intervention impacts individual, interpersonal, and social level factors related t risk behavior and testing. Using ethnography, we will follow a longitudinal cohort while the intervention is being fully implemented. 4) Examine the potential integration of biomedical HIV prevention methods into UBE through administering and analyzing quantitative data from the survey and qualitative data from the interviews. PUBLIC HEALTH RELEVANCE: Young black men who have sex with men (YBMSM) are contracting HIV at alarmingly high rates that far exceed other ethnic/racial groups and need an HIV prevention intervention that is culturally grounded, and helps them to reduce unsafe sex and increase the frequency of HIV testing. This intervention, United Black Element, creates an empowered, mobilized community of men who support each other about safer sex and testing and reaches all YBMSM throughout the community, whether they seek help to change their behavior or not. Community-level HIV prevention interventions such as this have been found in other studies to be very cost-effective, and thus is an excellent approach to pursue in terms of public health.