AIDS Project of the East Bay
Findings >  AIDS Project East Bay

African American Men Who Have Sex With Men

AIDS Project of the East Bay, Oakland, CA

If every new HIV infection involves a person with HIV, why do most prevention programs only target HIV- persons? People who have HIV deserve to have interventions to help them stay safe and play an active role in stopping the epidemic. In the Spring of 2001, AIDS Partnership California (APC) initiated the primary Prevention for Positives (P3) project, awarding grants to five CBOs to conduct formative research on what people of color with HIV want and need in an HIV prevention program. Three CBOs also developed programs based on the formative research findings.

Because little is known about the prevention needs of persons with HIV, conducting formative research is key to developing interventions that are effective, culturally sensitive and welcomed by the community served.

AIDS Project of the East Bay (APEB) serves primarily lower income African Americans in Alameda County, CA. For the P3 project, APEB focused on African American men who have sex with men (MSM) who have HIV and between the ages of 25 and 49. These men are generally low income and may or may not be currently receiving care services at APEB.

• African American MSM comprise a significant portion of the HIV epidemic in Alameda County, CA and across the nation.
  
  
• African American MSM are more likely to have HIV than MSM of any other ethnicity.
  
  
• In Alameda County, 22% of all persons with HIV are African American MSM. In addition, African American MSM make up 37% of all MSM HIV cases and 50% of all African American HIV cases.
  
  
• Among APEB clients who have HIV, 45% are African American MSM.
  

During the formative research phase, APEB and Aplomb Consulting did a literature search and conducted focus groups and individual interviews with African American MSM with HIV, community activists and service providers. Here's what the men said:

• There are a variety of personal and interpersonal reasons that men engage in unprotected sex:
  
  • Social isolation
    
  • Lots of spare time due to HIV-related illness or being on disability, with no place to go
    
  • No home, living in the street
    
  • Lack of self-esteem
    
  • Substance use and abuse
    
  • Physical abuse / domestic violence
    
  • Condom lessens sensation during sex
    
  • Can't get an erection with condom
    
  • Putting on a condom ruins the moment
    
  • Need to feel close to partner
    
  
  
• Men feel that current services are inadequate or not "client-centered" enough.
  
  • Service providers at CBOs are unprofessional
    
  • Have to be on death bed or drug user to get services
    
  • All services located downtown, not in local neighborhoods
    
  • Not enough mental health service providers
    
  
  
• Men listed what they would like to see in a prevention program:
  
  • Social activities
    
  • Address substance use and increase services for drug users
    
  • Address sexual orientation issues such as internal/external homophobia, religious condemnation, same gender loving
    
  • Services for sero-discordant couples
    

How APEB addresses these needs

1. To decrease social isolation
   
   
2. To reduce frequency of unprotected anal intercourse
   
   
3. To increase knowledge of safer sex strategies
   
   
4. To develop peer-based support
   
   
5. To increase the number of African American MSM with HIV who know their HIV status
   
   
6. To provide community support for safer sex practices among African American MSM with HIV
   
   
7. To provide safer sex skill-building opportunities for individuals and couples
   
   
8. To increase safer sex practice among couples
   
   
9. To reduce social isolation among couples attempting to utilize safer sex practices
   

Based on the formative research findings, APEB has designed and implemented a three-part P3 intervention for African American MSM.

I. Identify and Recruit AA MSM with HIV

• Conduct P3 information sessions to get the word out
  
  
• Make 1000 outreach contacts at popular venues (Oakland Dinner Club, Black Churches, Steamworks, Colleges)
  
  
• Establish linkages with other Alameda County testing programs and services (Berkeley DPH, CAL-PEP, SMAAC)
  
  
• Screen 400 participants
  
  
• Refer and/or test 100 people who don't already know their HIV status
  
  
• Develop protocol for peer-to-peer recruitment
  
  
• Develop and distribute 100 flyers and 2000 palm cards
  

II. Conduct Program Intakes

• Develop screening and program intake procedures and materials
  
  
• Conduct 280 intakes by end of grant cycle
  

III. Facilitate Group Level Activities

• Facilitate 40 sessions of weekly drop-in education and social support group for AA MSM with HIV
  Service goals
  
  • Serve 200 attendees per year
    
  • At least 25% of attendees (50) will be unduplicated
    
  • 25% of unduplicated attendees (12) will attend an average of 10 sessions
    
  
  
• Offer public social events
  
  • One small event for Kwanzaa 2001
    
  • One large event planned for 2002
    
  • Attendance goals: 200 attendees, with at least 50% African American MSM with HIV
    
  
  
• Offer Weekend Retreat
  
  • Planned for March 2002.
    
  • Attendance goals: 30 attendees, 100% African American MSM with HIV, 30% couples (5 couples)
    

Through February 2002, APEB has:

• Screened 100 participants
  
  
• Tested 20 individuals (2 have HIV)
  
  
• Distributed 150 flyers and palm cards
  
  
• Conducted 61 HIV+ program intakes
  
  • 100% African American
    
  • 85% gay identified
    
  • 10% on the Down Low
    
  • 5% Transgendered
    
  
  
• Held 8 weekly drop-in groups
  
  • 60 attendees total; average 7 per group
    
  • 22/66 attendees unduplicated
    
  • 56 men, 4 women, 1 bisexual (????)
    
  
  
• Held small public event for Kwanzaa 2001 (more?)
  

• High level of interest/participation from African American MSM
  
  
• Social isolation is decreasing. Members state they feel more supported and connected in the community.
  
  
• Requests for additional services. Members have requested one-on-one counseling appointments and a closed weekly group (in addition to drop-in).
  
  
• Interest/participation extending beyond African American MSM. Thre women have come to drop-in groups.
  
  
• Broader community support is growing. $1,000 has been donated without solicitation.
  

• Music in opening
  
  
• Affirmations via call and response
  
  
• Discussion topics generated by group
  
  
• Check-in and check-out
  

• People showed up when they with proper incentives and when reminded
  
  
• More challenging to get people to show up for one-on-one interviews
  
  
• People showed high levels of honesty and quickness to open up and tell the truth
  

• Utilize staff who are from the population to do the recruitment and conduct as much of the research as possible
  
  
• Utilize a variety of methods to gather information: surveys, groups, one-on-ones
  
  
• Take advantage of existing expertise of agency staff, community researchers
  
  
• Hire a program manager who is understanding and sympathetic of culture of clients, and possibly has HIV as well.
  

AIDS Partnership California (APC) is a private-public funding collaborative that includes foundation and corporate funders and the California State Office of AIDS.

APC is a program of Northern California Grantmakers, an association of 160 foundations and corporate giving programs.

Email: apc@ncg.org

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