Development of an HIV Risk Reduction Intervention for Older Seropositive African American Men

School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6096, USA.
AIDS patient care and STDs (Impact Factor: 3.5). 08/2009; 23(8):647-55. DOI: 10.1089/apc.2008.0276
Source: PubMed


The purpose of this study was to assess the feasibility and acceptability of an HIV risk reduction intervention to increase consistent condom use in a sample of older HIV-positive African American men who have sex with men (MSM). Repeated measures were used at baseline, immediate postintervention, and 3 months postintervention to collect data. The development of the intervention was implemented in four phases: focus groups, pilot testing of the questionnaire, modifying the intervention, and executing the intervention. Sixty HIV-positive African American MSM were randomized to either an HIV risk condition or a health condition. Each condition consisted of four 120-minute sessions delivered over a 4-week period in a classroom-like setting using interactive approaches. The primary outcome was consistent condom use during every instance of anal intercourse. In unadjusted analyses, men in the risk reduction group were twice as likely to use condoms consistently (odds ratio [OR] = 2.04; 95% confidence interval [CI] = 0.48-8.77; p = 0.336), although this did not reach statistical significance. All participants reporting consistent condom use at baseline reported consistent use at 3 months giving perfect prediction for the sample. Among men not reporting consistent condom use at baseline, those in the risk reduction group were 5 times more likely to report consistent condom use at 3 months than were those in the health condition (OR = 5.18; 95% CI = 0.97-27.78; p = 0.054). The findings suggest that an HIV risk-reduction condition may increase consistent condom use among HIV-positive African American MSM 50 years and older.

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    • "However, among men who did not report consistent condom use at baseline, exposure to the intervention was marginally associated with an increase in consistent condom use at 3 months (OR 5.18; 95% CI=0.97-27.78, p=0.054) [6]. "
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    ABSTRACT: Black men who have sex with men (MSM) are disproportionately burdened by HIV/AIDS. Despite this burden there has been a shortage of research on HIV interventions for black MSM. This article provides a comprehensive review of the literature on interventions for black MSM to identify effective HIV prevention intervention strategies for black MSM. We searched 3 databases: Pubmed, Scopus, and Google Scholar to identify peer-reviewed articles and used the following search terms: African American or black; MSM or men who have sex with men and women (MSMW); HIV; program or intervention; and evaluation or intervention science or implementation research. We included research articles that assessed interventions for black men who have sex with men. We included studies that used an experimental, quasi-experimental, or pre-post test design as well as formative research studies. We also searched the CDC and NIH websites to identify planned and on-going intervention studies. We identified a total of 23 studies to include in the review. We identified 12 completed studies of interventions for black MSM. Eight of these 12 interventions aimed to reduce HIV risk behaviors and 5 found a significant reduction in HIV risk behavior over time. We identified 4 health service intervention studies for young black MSM. Behavior change interventions are effective at reducing HIV risk behaviors among black MSM. However, relying only on behavioral interventions that aim to reduce HIV risk behavior will most likely not have a population-level effect on HIV infection among black MSM. There is a compelling and urgent need to develop and test comprehensive HIV testing, linkage to care, retention in care and adherence interventions for black MSM.
    BMC Public Health 07/2013; 13(1):625. DOI:10.1186/1471-2458-13-625 · 2.26 Impact Factor
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    • "The interventions targeted either universal or indicated prevention among older adults (Altschuler et al., 2004; Coleman et al., 2009; Falvo & Norman, 2004; Illa et al., 2010; Lovejoy et al., 2011; Orel et al., 2010; Rose, 1996; Small, 2010). Five of the studies evaluated universal prevention interventions among HIV negative older adults (Altschuler et al., 2004; Falvo & Norman, 2004; Orel et al., 2010; Rose, 1996; Small, 2010), whereas three of the studies targeted indicated prevention among HIV-positive older adults (Coleman et al., 2009; Illa et al., 2010; Lovejoy et al., 2011). Three of the studies did not mention the use of a theoretical framework (Altschuler et al., 2004; Falvo & Norman, 2004; Small, 2010). "
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    ABSTRACT: Objective: This study reviews the existing literature on the prevention of HIV among older adults, including universal and indicated prevention programs and prevention strategies. Method: A literature search was conducted between September and October of 2011 to identify studies for this review. Several different electronic databases and a combination of keywords were used to conduct the search. In addition, the reference section of each article was reviewed for additional articles. Results: A total of 18 articles were identified and reviewed. Three of the articles examined universal prevention, five of the articles examined indicated prevention, and the remainder of the articles provided strategies and recommendations for the prevention of HIV among older adults. Discussion: The existing studies document evidence for preventing future cases of HIV/AIDS among older adults. Additional studies and universal and selected interventions are needed in an effort to reduce the number of older adults being diagnosed with HIV.
    Journal of Aging and Health 10/2012; 24(8). DOI:10.1177/0898264312459347 · 1.56 Impact Factor
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    • "Unfortunately, little is known about the lives of Black MSM living in the USA, and even less is known about older HIV-positive Black MSM. In fact, we are aware of only one published study focusing on older Black seropositive MSM: an intervention study reporting a trend towards reduced risk behaviour among intervention participants (Coleman et al. 2009). More research focuses on younger racial/ethnic minority MSM living with HIV. "
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    ABSTRACT: In this paper, we analyse the life history narratives of 10 poor gay and bisexual Black men over the age of 50 living with HIV/AIDS in New York City, focusing on experiences of stigma. Three overarching themes are identified. First, participants described the ways in which stigma marks them as 'just one more body' within social and medical institutions, emphasising the dehumanisation they experience in these settings. Second, respondents described the process of 'knowing your place' within social hierarchies as a means through which they are rendered tolerable. Finally, interviewees described the dynamics of stigma as all-consuming, relegating them to the 'quagmire of an HIV ghetto'. These findings emphasise that despite advances in treatment and an aging population of persons living with HIV, entrenched social stigmas continue to endanger the well-being of Black men who have sex with men.
    Culture Health & Sexuality 04/2011; 13(4):429-42. DOI:10.1080/13691058.2010.537769 · 1.55 Impact Factor
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