Identifying Effective Interventions For African American MSM

Steven Tierney and Rafael M. Diaz, San Francisco AIDS Foundation
Social and Behavioral

The Black Brothers Esteem (BBE) program of the San Francisco AIDS Foundation (SFAF) is a ten-year old, reputationally strong HIV prevention intervention that targets low-income African American men who have sex with men, one of the most vulnerable populations in California with respect to HIV transmission. Prior evaluation work on the BBE program has addressed community perceptions of the program, barriers and facilitators to program participation and implementation, as well as client satisfaction and perceptions of program impact. Both qualitative and quantitative data have shown that the program, as currently implemented, is feasible, acceptable and highly regarded by both participants and the community at large. To date, however, there has been no systematic documentation of behavioral changes in BBE participants over time, particularly changes in sexual risk behavior or substance use factors that increase the risk for HIV transmission. The purpose of this project is to conduct an outcome evaluation that will assess changes over time in BBE participants' knowledge, attitudes, intentions, and behaviors relevant to reducing their risk of HIV transmission, as well as changes along those psychosocial, environmental, and substance-related predictors of HIV risk that the program aims to impact. The proposed evaluation will examine behavioral changes over a four- month period of BBE participation in 100 program participants using a baseline and four-month follow-up design. In addition, we will examine the relationship between different levels, types and intensity of program participation and behavioral changes over time in order to assess possible dose effects. The first two months of the project will be devoted to piloting an evaluation instrument that will assess, for each BBE participant, the following areas: Sexual Behavior; Substance use and abuse; HIV prevention knowledge, attitudes and intentions; Markers of life stability; Social support and sense of connectedness; Self-esteem and positive identity as a Black gay/bisexual man; Community involvement and sense of purpose in life; Holistic (physical, emotional, sexual and spiritual) health and wellbeing; Access and utilization of medical care; and Demographics. The proposed evaluation will answer two important questions: 1) Whether BBE participants do indeed change--after four months of program participation--along expected behavioral and psychosocial dimensions, and reduce their risk for HIV transmission as aimed by the program's mission; and 2) Whether changes observed are related to the frequency and type of BBE participation. The proposed documentation of participant changes over time constitutes the first step towards evaluating the effectiveness of the program in a randomized controlled trial at a later time.