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)

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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

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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

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Phase I Formative Research to Modify MP

• Boards of Cultural Experts (BOCEs)
• N21, 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)
• N34
• 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

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Dual identity/Internalized Oppression
Issues that emerged
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Other key issues that emerged
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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

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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

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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 dont
  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

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Lack of Adult Male Role Models

• Many YBMSM have not had adult men in their lives
• No vision about what an older BMSMs 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

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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/internali
  zed oppression

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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.

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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)

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Translation Research Challenges

• 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

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Challenges Continued

• 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

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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)