A community-based intervention to increase PrEP initiation among Black sexual minority men in Prince George's County, Maryland: Reducing internalized stigma and increasing social support

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ABSTRACT My goal in pursuing a Mentored Research Career Development Award is to gain the necessary training, knowledge, and practical experience needed to become an independent investigator focused on improving access to and utilization of PrEP among Black men who have sex with men (BSMM) through social, peer- based intervention research. To continue my progress towards my career goals, I propose to conduct an intervention focused on increasing PrEP acceptability through developing and maintaining peer support and resilience to intersectional racism and homophobia among BSMM in Prince George’s County, MD. Despite a clear, well-documented need for greater uptake of PrEP among BSMM in this county, PrEP uptake among BSMM in this setting remains low, and extant literature specific to PrEP use in this setting and population is extremely limited. To address this need, I propose the following: Specific Aims: 1) Understand peer-peer interactions/exchanges and HIV prevention communications among BSMM through ethnographic qualitative observations (participant and direct) of two ongoing MPowerment models, 2) conduct qualitative in depth interviews to inform designing an intervention to reduce internalized racism, internalized homophobia and increase PrEP initiation among BSMM in PG County, and 3) pilot test a community-based intervention (130 participants) to reduce internalized racism, internalized homophobia, and HIV stigma and increase social support and PrEP initiation among BSMM in PG County, based on the MPowerment model. In addition to my specific aims, my Specific Career Development Aims are the following: 1) To develop expertise in the analysis of qualitative data, particularly related to social and structural factors, 2) to develop expertise in the collection and analysis of network data collected via respondent driven sampling, 3) to gain experience in the design, conduct, and evaluation of interventions and 4) to develop research management and professional development skills needed to lead future independent research projects. The knowledge and experience gained from the proposed research will provide me the skillset necessary to successfully compete for R01 funding to conduct a larger scale peer-focused intervention to promote PrEP acceptability and adherence among BSMM. The proposal makes significant contributions to the field in several ways, including 1) identifying barriers to PrEP acceptability among BSMM in Prince George’s County, 2) Qualitatively understand factors that may impact observed quantitative associations between barriers and PrEP use and acceptability, and 3) developing and evaluating an MPowerment intervention to improve PrEP use and acceptability in this population. My rigorous education, training, and research experience in social determinants of HIV/STI risk, collaborations with BSMM populations and organizations, proficiency with quantitative data analysis, and the expertise of my multidisciplinary research team, uniquely prepares me to conduct the proposed research and significantly contribute to HIV prevention science.