African American Mpowerment Project: HIV Prevention for Young MSM

1. African American Mpowerment Project: HIV Prevention for Young MSM Susan Kegeles, CAPS Greg Rebchook, CAPS Michael Foster, CAPS Roosevelt Mosby, SMAAC (Oakland) Elder Claude Bowen, MAP/Unity Fellowship Church (LA) Phill Wilson, Black AIDS Institute (LA)

2. The Mpowerment Project (MP) • Demonstrated effectiveness • Listed in CDC Compendium of HIV prevention interventions with evidence of effectiveness • Scientifically tested in several communities • Communities were primarily white and Latino/Hispanic • Community-level project with multiple components • Creates healthy community • Promotes supportive friendship networks • Disseminates a norm of safer sex throughout the community

3. Appropriate HIV prevention interventions for YBMSM are necessary • Only 1 intervention for Black MSM men has been developed and rigorously tested (Peterson 1996) • New community-level interventions that address multiple issues through a variety of channels and activities are needed • MP has not reached YBMSM before; clearly needs to be translated to meet their needs

4. We are adapting and pilot-testing MP with young black MSM • Community collaborative research is necessary • 3 African American CBOs and CAPS are partnering

5. Goals of Translation Project • Determine how to modify the Mpowerment Project for YBMSM, ages 18-30 (Phase I) • Develop the modified Project (Phase II) • Implement the modified Project for 12 months (Phase III) • Evaluate success of the translation process • Identify organizational, setting, researcher, and population characteristics that impede or facilitate implementation

6. Phase I: Formative Research to Modify MP • Boards of Cultural Experts (BOCEs) • N=21, older men, all “MSM”, identities varied (gay, SGL, het) • 1 Board each in LA & Oakland area • 10-11 members each • Knowledgeable and thoughtful about the target population • Received $500 for participation • One 2-day training and 8 Board meetings (4 in Oakland, 4 in LA) • Focus Groups with YBMSM (18-29 year olds) • N=34 • 6 groups of 8-10 men (4 in LA, 2 in Oakland, additional groups will be held in Oakland) • Participants received $50 • Analyzed themes that arose in various groups

7. Privacy Concerns Whole-man approach Cultural appropriateness of M-groups Diverse sexual identities HIV testing Bisexuality Lack of role models More HIV+ men Fatalism Dual identity/Internalized Oppression Issues that emerged

8. Creating young black gay/SGL community HIV is just one of many issues Violence Class distinctions Treatment optimism Sexual abuse Racism in gay community Stigma Inter-generational sex Drug use Black institutions and expectations Masculinity/Femininity Church/religiosity Other key issues that emerged

9. Internalized Oppression • YBMSM are an oppressed minority within a stigmatized minority • Many YBMSM internalize homophobic messages from the black community and internalize racist messages from the larger society • Negative consequences result in how regard & care for self & partners • How to modify MP: • Emphasize pride in being African American & pride in same sex attractions • Adapt existing M-group to focus on these issues and/or develop new group

10. Emphasize Whole-man • YBMSM do not want to be reduced to their sexual activities, sexual desires • Recognize that their identity includes family, spirituality, community, history… • They face difficult issues: • Discrimination • Biased criminal justice and socioeconomic systems • Institutional and overt acts of racism • Fatalism, hopelessness, and loss of control • An unwelcoming and unsupportive “mainstream” gay community • How to modify MP: • address multiple facets of becoming a fully functioning adult man • Wellness, exercise, connection to spirituality • Job and life-skills training, resume writing, interviewing, finances, banking, housing, literacy

11. Diverse Sexual Identities • YBMSM have a variety of sexual identities & many are reluctant to join a “gay” project • Many YBMSM have sex with women • However, many black MSM do have a strong gay identity and are at risk for HIV • How to modify MP: • Keep project as welcoming as possible for gay/SGL-identified men and men who don’t self-label based on their sexual activities • Avoid the term gay • Primarily design the project for men with some sense of identity around their same-sex desire or attraction • Use more subtle language and be more ambiguous in visual imagines and words than previous projects • Modify publicity of project, activities, groups

12. Lack of Adult Male Role Models • Many YBMSM have not had adult men in their lives • No vision about what an older BMSM’s life is like • BOCEs and focus groups raised mentoring as an important issue • How to modify MP: • Change CAB - members as mentors • Train mentors in work • Create safe venues for mentors to socialize with YBMSM • Seminars, panel discussions and other forums for YBMSM to learn from the mentors

13. HIV Testing & Treatment Issues • High seroprevalence rates • Increased emphasis on getting HIV+ men to know serostatus & obtain treatment • How to modify MP: • Not focused on at all in MP • Develop messages that YBMSM can use to encourage each other to get tested & feel okay about treatments • Important to destigmatize HIV+ men • Enhance referrals to HIV testing sites where YBMSM will feel welcome

14. Changing M-groups • Issues in current M-groups are relevant & important to YBMSM - but insufficient • YBMSM dislike current format of teaching (“pedagogy”) • must revise M-groups • Will conduct additional Focus Groups • More culturally relevant & appropriate exercises (eg, music, affirmations, spoken word) • Create safety so sharing can be less superficial • Increase variety to allow more role-playing with different kind of sexual partners • Expand beyond 1 session - yet balance with how many sessions young men are willing to attend • Address “whole-man” issues & empowerment/internalized oppression

15. Church/Religiosity/Spirituality • Frequently mentioned • Mentioned by those who feel alienated from the church and those who still participate in it • A need exists for YBMSM to discuss how religion affects them • How to modify MP: • Goals: • Give people options for spirituality • Help men find peace with their spirituality & sexuality • Panels, discussion groups, etc.

16. Phase III: Implement Project for YBMSM • Each community organization will run the project • 12 months of implementation • 2 programs in LA operated jointly; 1 program in Oakland • Researchers provide on-going support • Materials (training manuals, videos, facilitator guides) • Trainings (initial 3-day; on-site follow up) • On-going technical assistance (via phone, e-mail) with constant feedback about evaluation results • On-line services (website, online materials, Listserv, chat room)

17. When we really asked the community for ideas about how to change the intervention - to “deconstruct the intervention” - the scope & depth and scope of their comments were substantial Risk behavior among YBMSM occurs in a very different cultural, economic, & social context from the original communities Modifying the intervention is not just a matter of adjusting the project for a slight cultural “nuance” Translation Research Challenges

18. Re-designing the intervention requires developing new components& considerable re-framing of current components Phase II - developing adapted intervention - is time-consuming and requires a great deal of pilot-testing, careful evaluation, trial and error, re-designing, and re-implementing - far more than we had anticipated Challenges Continued…

19. Challenges Continued… • When is a new efficacy study required? • Ultimately, a new efficacy study seems needed when new Core Elements are required, when existing Core Elements are significantly modified from original intervention, & when intervention is conducted in very different context - hope to do this in NIH-funded study eventually • First goal is to learn if the modified Project is acceptable to the new target population (this study)