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) 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 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 Community collaborative research is necessary 3 African American CBOs and CAPS are partnering

Goals of Translation Project 1.Determine how to modify the Mpowerment Project for YBMSM, ages (Phase I) 2.Develop the modified Project (Phase II) 3.Implement the modified Project for 12 months (Phase III) 1.Evaluate success of the translation process 2.Identify organizational, setting, researcher, and population characteristics that impede or facilitate implementation

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

Dual identity/Internalized Oppression Whole-man approach Diverse sexual identities Lack of role models Fatalism More HIV+ men HIV testing Cultural appropriateness of M-groups Issues that emerged Privacy Concerns Bisexuality

Treatment optimism Church/religiosity Masculinity/Femininity Stigma Other key issues that emerged Creating young black gay/SGL community Violence Sexual abuse HIV is just one of many issues Racism in gay community Black institutions and expectations Drug use Class distinctions Inter-generational sex

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 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 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 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 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 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 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 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, ) 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”

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… 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)