UARP Annual Meeting San Francisco, CA February 10, 2006

1. INSERT AB TITLE UARP Annual Meeting San Francisco, CA February 10, 2006 Nina T. Harawa, John K. Williams, Hema C. Ramamurthi, Sergio Avina, Cleo Manago, Kevin Pickett, Tony Wafford

2. Semi-Structured Focus Groups Interviews • Recruitment • Direct recruitment • Posting of flyers • Referrals from other participants • Clients of drug treatment center • Eligibility requirements (self report): • Male • 18 years or older • African American • Had sex with a male partner in the past 12 month • Did not identify as gay

3. Reporting on responses to the following two sets of focus group questions: • What are the general thoughts about condom use among African American MSM? Do condoms really protect people? Under what circumstances do African American MSM use condoms? • How does being infected with HIV/AIDS or other STDs affect the sex lives of African American MSM? Do they continue to have sex? Do they disclose? Do they use condoms?

4. Data Collection • Focus groups were conducted by a male facilitator (the recruiter) who was familiar with the issues facing African American NGI MSM/W • Discussions were audio-taped and transcribed • At the end of the discussion, participants were asked to complete a short demographic survey that was voluntary • Participants were paid $40 cash as incentive

5. Data Analysis • Constant comparison method of data analysis (Strauss and Corbin,1975) • Three readers read the transcripts, coded phenomenon, and applied the codes to other similar phenomenon in the text. • This process was repeated until entire transcripts were coded and no new codes originated. • Interview transcripts were organized and analyzed using Atlas.ti 5.0 software

6. 30 men participated in the group discussion, 29 completed the post survey Socio demographics Average age was = 41 (SD 9) Education High school or vocational/technical trade = 47% ( n=14) Some college = 27% ( n= 8) College completed = 10% ( n= 3) Some graduate school = 10% ( n= 3) Employment: Unemployed/Disabled = 53% ( n= 16) Full time/Part time = 40% ( n= 12) Sexual Identity “Heterosexual” 4 “Bisexual” 10 “Gay” 10 “Same Gender Loving” 1 “Down Low” 1 “Homosexual” 2 “Other” 1 Type of sexual partner(s) Just men 62% (n= 18) Just women 7% (n= 2) Both men and women 28% (n= 8) Neither 3% (n=1) Results (update)

7. Condom use among African American MSM • Protection • HIV infection • HIV reinfection • STD infection • Pregnancy • Aesthetics • Loss of sexual pleasure versus prolonged erection • Fear of disclosure • Distrust of condoms • Substance use

8. Condom Use – Protection Protection from disease and pregnancy “with MSM um, more specifically with AA men, condoms is equated to health. So, you have to deal with the whole concept of being healthy. Making healthy choices, prevention. So, when you deal with those condoms, if you don't equate condoms to health or condoms to life, why am I using it? You know, um, but then with a woman, you know, if you're having sex with a woman, you equate a condom with maybe protection from STDs but no children. So, you equate condoms with money. You know. So, with men, it's condoms, you know, with health. With women, condoms, children, money.”

9. Condom Use - Aesthetics The experience of using condoms was often associated negatively with loss of sensation, but some participants saw this as positive. Participant A3: “They keep me hard and make the .. last longer …It makes it last longer than me, I think.”

10. Condom Use – Fear of disclosure Condom use with female partners was seen as carrying risky social/relationship implications. “..for example, on the down low brother type thing. This man and his wife are having sex. He goes out and has sex with a man. And he comes home now and wants to put on a condom. My wife is like, well, why you going to put that on. We haven't been using it for such a long time. So now he has a fear of putting on a condom because the wife wants to know why you're putting on a condom. Uh, my tubes are tied, I can't get pregnant. What's going on? Are you doing something out there? So it creates a lot of questions.”

11. Condoms - Distrust of condoms Participants reported not trusting condoms for disease protection and experiencing condom failure. (HIV- Participant) “Just because you put on a condom doesn't mean that you do or don't. You know, a condom ain't going to save you. The hell, no….”

12. Condom use- Exchange/survival sex Exchange sex could be a motivator to use or not use condoms. “When you're prostituting and you're turning tricks and stuff like that, you don't have time to put on condoms. You are too busy trying to get your money.” Drug use sometimes derailed intentions to use condoms. “I don't think so. I think that, uh, the reason that most men don't use condoms is that they either are intoxicated or they are on some type of drug and they are caught up in the heat of the moment and they don't stop to think. I think the majority of people that are about to engage in sex with a clear mind would pull out a condom and put it on.”

13. The impact of being infected with HIV on the sexual lives of African American MSM • Rejection and isolation • Reduced sexual activity • “…for me, being HIV positive it cuts, it, it, my sex life is short, actually. Uh, I'm not in a relationship. I don't look for relationships and basically, if you meet someone new, we might hit if off and be compatible, have a lot of things in common. Then you have to disclose because you have to disclose. It's the only male thing to do. It's just right. But then once you disclose, then they could be negative, and if they are, they might not be educated on the virus. There goes the rejection. . . “

14. Theoretical Framework Theory of Reasoned Action Theory of Planned Behavior

15. Behavioral Beliefs d3 Past Condom use Attitudes d2 d4 Values Condom use with partners Intentions Normative Beliefs d1 Subjective Norms Control Beliefs Comply

16. Self-protection Protection of others Questioning Condom failure Loss of $$ Loss of sensation d3 Past Condom use Attitudes Substance use Health Responsibility Money/Basic needs Secrecy/privacy Children d4 Lack of critical thinking Condom use with partners Intentions Planning for condoms Engaging in less sex Normative Beliefs Substance use Control Beliefs Self-efficacy Subjective Norms Comply

17. Implications for Intervention • Subjective norms re: condom use may be less important for NGI than GI men • Successful intervention should • Identify for what participants value and make the connection to safer sex • Address why some participants do not value protecting themselves or others • Directly address distrust, negative experiences, and aesthetic issues related to condom use • Strategize around condom use while under the influence or hustling