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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). The Mpowerment Project (MP).

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african american mpowerment project hiv prevention for young msm

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)

the mpowerment project mp
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
appropriate hiv prevention interventions for ybmsm are necessary
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
we are adapting and pilot testing mp with young black msm
We are adapting and pilot-testing MP with young black MSM
  • Community collaborative research is necessary
  • 3 African American CBOs and CAPS are partnering
goals of translation project
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
phase i formative research to modify mp
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
slide7

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

slide8

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

internalized oppression
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
emphasize whole man
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
diverse sexual identities
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
lack of adult male role models
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
hiv testing treatment issues
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
changing m groups
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
church religiosity spirituality
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.
phase iii implement project for ybmsm
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)
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”

Translation Research Challenges
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

Challenges Continued…
challenges continued1
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)
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