The Accelerating Excellence In Translational Science (AXIS)Charles Drew University of Medicine and Science

Thursday, August 01, 2013

A study just published in the journal AIDS describes a promising intervention, one designed to help reduce risky sexual behavior in black men who have sex with men and women (MSMW). The study’s first author is Nina T Harawa, MPH, PhD, an Associate Professor at CDU and an adjunct faculty member at UCLA. To perform the intervention and research analysis, Dr. Harawa and colleagues collaborated with three community based agencies in Los Angeles that provide a range of services to at-risk and HIV-infected clients.

The need for such successful behavioral intervention programs is high. Close to half of all new HIV infections in the US occur in African Americans. Almost three-fourths of new HIV infections in black men are related to sexual encounters with other men, and many of these men may infect their female partners. The rates of HIV infection in black men who have sex with men are higher than in similar white or Hispanic men. Despite this, until now few interventions have targeted black men who have sex with men or with both men and women.

Older interventions targeted to gay-identified men may not work well with many black MSMW. These men often do not identify with gay communities. They may also have concerns about fulfilling traditional gender expectations and maintaining ongoing relationships with both men and women.

This most recent intervention takes a different approach. The intervention, termed MAALES (Men of African American Legacy Empowering Self), emphasizes a shared African American heritage and addresses societal and gender expectations. As Dr. Harawa and colleagues note, “Holistic HIV interventions may be vital for groups like black men who have sex with men and women whose concerns regarding HIV stigma, bi/homophobia, and financial hardship may complicate engagement in biomedical prevention and HIV treatment.”

The researchers studied over 400 African American men who had at least one sexual experience with a female in the past 24 months and one or more with a male in the same period. These men were separated into two groups. The control group received a standard 15-20 minute session on HIV education and risk reduction.

In contrast, members of the MAALES group received six 2-hour group sessions conducted over three weeks, followed by booster sessions at six and eighteen weeks after completion. The group sessions gave participants a comfortable setting in which to discuss sensitive topics, focusing on past experiences and social expectations of African American men, risky behaviors, HIV testing, developing risk-reduction goals, and identifying motivators for preserving health in all areas of life. These sessions emphasized not just the well-being of participants, but that of the other individuals intimately related to participants. These African American men participants consistently provided positive feedback about the sessions, and session attendance was high throughout the intervention.

Compared to those who received the control intervention, individuals who assigned to the MAALES session reported significantly fewer episodes of unprotected sex with female partners and fewer female partners overall. The participants also reported significantly decreased numbers of sex acts with either males or females. The approach might also ultimately be effective in reducing the number of male partners and unprotected sex with men, though this was not definitively shown in the present study. The intervention did not, however, decrease the likelihood of sex under the influence of risky drugs.

The findings underscore the promise of this type of intervention to bring about important behavior change and ultimately decrease rates of HIV infection. The investigators are now completing a trial that examines a related intervention in men recently released from incarceration. They plan to work with the Centers for Disease Control and Prevention to become one of the standardized interventions that the agency routinely funds.