Public health responses to the HIV epidemic among black men who have sex with men: A qualitative study of US health departments and communities

Examining HIV Organizational Structures and their Influence on Engagement with Young Black Gay, Bisexual, and other Men who have Sex with Men in Atlanta, Georgia

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV. Structural influences on these disparities, including characteristics of the various organizations that serve YB-GBMSM living with HIV, remain understudied. We drew on Weick's model of organizing to conduct and analyze qualitative interviews with 28 HIV service providers representing healthcare and community-based organizations in Atlanta, Georgia. Enactment of HIV service provision was described as following simplified and standardized responses-defined as "rules", and/or more dynamic exchanges to formulate responses -otherwise known as "communication behavior cycles" (CBCs). Rules, including patient quotas and limited hours of operation, were viewed as rigid, out-of-touch, and inhibiting engagement with YB-GBMSM. CBCs, such as patient feedback loops and rejection of traditional hierarchies, fostered creative insights to combating the epidemic and increased levels of cultural awareness and community buy-in. Organizations should strive to enact CBCs, to foster culturally congruent approaches to service delivery for YB-GBMSM.

Pilot Trial of a Critical Consciousness-Based Intervention for Black Young Gay and Bisexual Men Living with HIV: Mobilizing Our Voices for Empowerment (MOVE)

HIV in the USA disproportionately affects Black young gay and bisexual men (Y-GBM). This article presents outcomes of a pilot randomized controlled trial comparing Mobilizing our Voices for Empowerment (MOVE), a culturally and developmentally tailored critical consciousness-based intervention for Black Y-GBM living with HIV (ages 16-24), with a comparison health promotion intervention. Black Y-GBM (n = 54) from four cities participated. Mixed effects models across four assessment points revealed participants in MOVE showed greater increases over time in perceived stress of HIV disclosure, self-efficacy for limiting HIV risk behavior, and condom use self-efficacy. Examining mean difference scores separately, participants in MOVE demonstrated increases in self-efficacy for HIV disclosure, perceived policy control, and self-efficacy for limiting HIV risk behavior. Immediately post-intervention, MOVE participants reported greater decreases in condomless intercourse with negative/unknown partners. MOVE may have potential to improve the health of Black Y-GBM living with HIV and reduce further transmission.

Lessons from +LOVE, Improving HIV Care for Black Men Who Have Sex with Men in New Orleans Using an Integrated Behavioral Health Crisis Support Model of Care

Black men who have sex with men (BMSM) experience higher rates of HIV infection than other groups. They also face disparities in linkage and retention to HIV care, as well as in viral suppression. To address the needs of the BMSM population living with HIV, we developed a novel intervention program (+LOVE), which integrated case management with behavioral health/crisis support. The intervention consisted of (1) a dedicated therapist; (2) an SMS (text message)-based engagement program, CareSignal that provided medication reminders and administered routine ecological momentary assessments (EMAs); (3) a triage crisis coordinator to respond to alerts generated by the EMA responses; and (4) a case manager. This study assessed the additional impact of the first three components of the intervention (a dedicated therapist, text messaging application, along with a triage crisis coordinator), compared with the fourth component alone, the current standard of care (a case manager) on access to HIV care, antiretroviral therapy (ART) adherence, and viral suppression. Analyzing electronic medical record data, survey data, and EMA response data extracted from CareSignal, we found that those who engaged in the behavioral health therapy had higher odds of remaining in HIV care than those who only engaged with the case manager. We also found that increased engagement with CareSignal led to an increased probability of achieving positive HIV-related health outcomes. Our results suggest that an integrated behavioral health/crisis support model of intervention integrated with case managementincreased positive outcomes over case management alone.

Optimizing PrEP Continuance: A Secondary Analysis Examining Perceived Autonomy Support and Care Coordination Quality among Black MSM in HPTN 073

At the end of year 2018, it was estimated that in the United States over 1 million people were living with HIV. Although Black/African American individuals comprise an estimated 13.4% of the US population, as of 2019, they represented an estimated 42% of all new HIV diagnoses in 2018. PrEP use among Black men who have sex with men has not reached levels sufficient to have a population impact on HIV incidence. The purpose of this study was to examine whether high perceived autonomy support and care coordination quality were associated with PrEP continuation. Secondary analyses were conducted on data with 226 Black MSM in three US cities. Participants who were PrEP users and scored higher on autonomy support at week 8 were significantly more likely to continue PrEP (OR 1.48; 95% CI 1.04-2.11). Perception of coordination quality did not differ between PrEP users and non-users at any of the visits. Although coordination quality was not statistically significant, greater than half of PrEP users and non-PrEP users utilized the C4 services. Addressing social, individual, and structural barriers to PrEP may benefit Black MSM irrespective of their PrEP use.

Standardized metrics can reveal region-specific opportunities in community engagement to aid recruitment in HIV prevention trials

Good Participatory Practice (GPP) guidelines support and direct community engagement practices in biomedical HIV prevention trials, however no standardized metrics define the implementation and evaluation of these practices. Collaboratively, the Community Program staff of the HIV Vaccine Trials Network (HVTN) and the HIV Prevention Trials Network (HPTN) created a metric to describe, monitor, and evaluate one component of GPP, recruitment practices, in two HIV monoclonal Antibody Mediated Prevention (AMP) clinical trials, HVTN 703/HPTN 081 and HVTN 704/HPTN 085. Through consultation with community representatives from each clinical research site (hereafter “site(s)”), who made up the study Community Working Groups, recruitment strategy descriptors were developed for both trials to characterize responses to “How did you hear about the AMP study?” The Community Working Groups also helped to define and establish time points that were selected to allow comparisons across sites. Data were collected by 43 of 46 clinical research sites from January 1, 2017 to February 28, 2018. All 43 sites used multiple recruitment strategies successfully, but strategies varied by region. Globally, referrals was the most efficient and effective recruitment strategy as evidenced by the screening: enrollment ratio of 2.2:1 in Africa, and 2.1:1 in the Americas/Switzerland. Print materials were also valuable globally (3:1 Africa, 4.2:1 Americas/Switzerland). In Africa, in-person outreach was also quite effective (2.3:1) and led to the most enrollments (748 of 1186, 63%). In the Americas/Switzerland, outreach was also effective (2.6:1), but internet use resulted in the most screens (1893 of 4275, 44%) and enrollments (677 of 1531, 44%), compared to 12 of 2887 (0.4%) and 2 of 1204 (0.1%) in Africa, respectively. Standardized metrics and data collection aid meaningful comparisons of optimal community engagement methods for trial enrollment. Internet strategies had better success in the Americas/Switzerland than in sub-Saharan African countries. Data are essential in outreach staff efforts to improve screening-to-enrollment ratios. Because the effectiveness of recruitment strategies varies by region, it is critical that clinical research sites tailor community engagement and recruitment strategies to their local environment, and that they are supported with resources enabling use of a range of approaches.

Development of a Black Caucus within the HIV Prevention Trials Network (HPTN): Representing the Perspectives of Black Men Who Have Sex with Men (MSM)

Black men who have sex with men (MSM) have disproportionate HIV disease burden in the United States. Black MSM have been underrepresented in biomedical research, including HIV clinical trials, due to a myriad of socio-structural, socio-cultural, and psychosocial factors. The HIV Prevention Trials Network (HPTN) 061, a feasibility study of a multi-component HIV prevention intervention for Black MSM in six US cities, incorporated the development and implementation of a Black Caucus as a culturally grounded model for the integration of Black MSM in clinical trials and research in HPTN. Based on a qualitative methodological approach, we describe the formation and implementation of the Black Caucus from the perspective of Black MSM key community stakeholders. Three major themes emerged from the qualitative narratives: (1) the role of the Black Caucus in shaping the HPTN, (2) how the Black Caucus addresses the needs of Black MSM communities pertaining to the influence of race and sexual identity, and (3) socio-cultural needs of Black MSM. These findings have implications for the provision of culturally congruent expertise, community engagement, cultural mistrust, recruitment and retention of Black MSM in HIV clinical trials, culturally-relevant study design and implementation, and the role of developing Black MSM prevention researchers.

Community-Based Organization Adaptations to the Changing HIV Prevention and Care Landscape in the Southern United States

Community-based organizations (CBOs) provide HIV prevention services throughout the United States, including the South where HIV/AIDS burden is high. We assessed Southern CBO response to changes in the HIV prevention landscape, including the National HIV/AIDS Strategy, and the Centers for Disease Control and Prevention's (CDC's) High Impact Prevention. Both strategies aim to improve outcomes for people living with or at high risk for HIV. Inductive qualitative analysis of interviews and consultations with CBOs, capacity building assistance providers, and CDC staff revealed CBOs are building clinical service capacity and cross-agency partnerships to adapt, but face inadequate or reduced funding. A holistic approach to HIV prevention and care in the South is critical, where stigma and other socio-structural factors limit health care options for persons affected by HIV. Health care organizations may benefit by partnering with CBOs because CBOs have the skillsets and community rapport to effectively improve health outcomes of persons living with HIV.

Critical Consciousness-Based HIV Prevention Interventions for Black Gay and Bisexual Male Youth

Black gay/bisexual male youth are one of the groups most affected by HIV in the U.S., but few behavioral interventions have been created specifically to address this health inequity. Oppression related to these youths' multiple social identities - including racism, heterosexism, and HIV stigma - contribute to increased health risks. Primary and secondary HIV prevention interventions created specifically for Black gay/bisexual male youth that address the negative impact of oppression are urgently needed. We present empowerment as a framework for understanding how oppression affects health, and critical consciousness as a tool to be utilized in behavioral interventions. This approach helps to move Black gay/bisexual male youth from a place of oppression and powerlessness that leads to elevated health risks to a position of empowerment that promotes feelings of control and participation in healthy behaviors. Finally, we present a case example of our own critical consciousness-based secondary HIV prevention intervention created specifically for Black gay/bisexual male youth.

Quality of HIV Websites With Information About Pre-Exposure Prophylaxis or Treatment as Prevention for Men Who Have Sex With Men: Systematic Evaluation

Background

Knowledge and uptake of high-efficacy HIV prevention strategies such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) remain low among men who have sex with men (MSM) who are at the highest risk for HIV infection in the United States. Electronic health (eHealth) interventions are promising tools for disseminating information about these critical yet underutilized strategies and addressing key barriers to uptake among target populations. However, existing HIV prevention websites are understudied and unevaluated.

Objective

This study aimed to systematically review and evaluate existing HIV websites that include information about PrEP or TasP for MSM.

Methods

From March 2018 to May 2018, 2 trained research assistants (RAs) entered relevant key words and phrases into 3 commonly used search engines and applied exclusion criteria to all returned results to identify 31 websites included in this review. RAs independently scored each website for authority, usability, interactivity, and PrEP/TasP-related content based on a standardized rating scale and then averaged the results.

Results

No website received a perfect score in any of the 4 categories, and the average website score was 62% (37/60). Less than a quarter of the websites (23%, 7/31) received a score of more than 75% (7.5/10) for content. Approximately two-thirds of the websites (65%, 20/31) received a score of 50% (5/10) or lower for interactivity. The average score in usability was 68% (6.8/10) and in authority was 69% (6.9/10). Other deficiencies observed included difficulty locating relevant content and lack of information targeting audiences with the highest likelihood of HIV infection.

Conclusions

Existing HIV prevention websites with information about PrEP or TasP for MSM fail to provide adequate content as well as present that content to users in an interactive and audience-conscious way. Future eHealth interventions should attempt to rectify these deficiencies to successfully engage and educate MSM at high risk for HIV regarding prevention strategies.

Using eHealth to Reach Black and Hispanic Men Who Have Sex With Men Regarding Treatment as Prevention and Preexposure Prophylaxis: Protocol for a Small Randomized Controlled Trial

BACKGROUND

Black and Hispanic men who have sex with men in the United States continue to be disproportionately affected by HIV and AIDS. Uptake of and knowledge about biobehavioral HIV prevention approaches, such as treatment as prevention and preexposure prophylaxis, are especially low in these populations. eHealth campaigns and social media messaging about treatment as prevention and preexposure prophylaxis may help to fill this gap in knowledge and lead to increased uptake of such strategies; however, no evidence exists of the effects of these targeted forms of communication on treatment as prevention and preexposure prophylaxis uptake in these populations.

OBJECTIVE

We describe the protocol for a 3-part study aiming to develop and evaluate an eHealth intervention with information about treatment as prevention and preexposure prophylaxis for HIV-positive and HIV-negative black and Hispanic men who have sex with men.

METHODS

Phases 1 and 2 will involve focus groups and cognitive interviews with members of the target populations, which we will use to create a culturally tailored, interactive website and applicable social media messaging for these men. Phase 3 will be a small randomized controlled trial of the eHealth intervention, in which participants will receive guided social media messages plus the newly developed website (active arm) or the website alone (control arm), with assessments at baseline and 6 months.

RESULTS

Participant recruitment began in August 2017 and will end in August 2020.

CONCLUSIONS

Public health interventions are greatly needed to increase knowledge about and uptake of biobehavioral HIV prevention strategies such as treatment as prevention and preexposure prophylaxis among black and Hispanic men who have sex with men. eHealth communication campaigns offer a strategy for engaging these populations in health communication about biobehavioral HIV prevention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03404531; https://www.clinicaltrials.gov/ct2/show/NCT03404531 (Archived by WebCite at http://www.webcitation.org/70myofp0R).

REGISTERED REPORT IDENTIFIER

RR1-10.2196/11047.

Selection and Evaluation of Media for Behavioral Health Interventions Employing Critical Media Analysis

Although a growing number of psychosocial health promotion interventions use the critical analysis of media to facilitate behavior change, no specific guidelines exist to assist researchers and practitioners in the selection and evaluation of culturally relevant media stimuli for intervention development. Mobilizing Our Voices for Empowerment is a critical consciousness-based health enhancement intervention for HIV-positive Black young gay/bisexual men that employs the critical analysis of popular media. In the process of developing and testing this intervention, feedback on media stimuli was collected from youth advisory board members (n = 8), focus group participants (n = 19), intervention participants (n = 40), and intervention facilitators (n = 6). A thematic analysis of qualitative data resulted in the identification of four key attributes of media stimuli and participants' responses to media stimuli that are important to consider when selecting and evaluating media stimuli for use in behavioral health interventions employing the critical analysis of media: comprehension, relevance, emotionality, and action. These four attributes are defined and presented as a framework for evaluating media, and adaptable tools are provided based on this framework to guide researchers and practitioners in the selection and evaluation of media for similar interventions.

Sexual Health Research With Young Black Men Who Have Sex With Men: Experiences of Benefits and Harms

Young Black men who have sex with men (YBMSM) are often underrepresented in sexual health research because of concerns about safety, privacy, and the potential for research harms. Empirical data are needed to understand YBMSM experience of participating in research, benefits and harms (discomfort), to inform policy and regulatory decisions. Using qualitative methods, this article examines 50 YBMSM, aged 15-19 years, experiences of benefits/harms, challenges of participating in sexual health research, and contextual factors impacting research experiences. Participants were asked about benefits and harms experienced in answering questions about sexual orientation, first same-sex attraction, and same-sex sexual experiences after completing an in-depth interview. Interviews were transcribed and coded. Inductive open coding was used to identify themes within and between interviews. Participants were able to describe perceived direct benefits resulting from research interview participation, including awareness of risky sexual behaviors, a safe space to share early coming out stories and same-sex sexual experiences, and a sense of empowerment and comfort with one's sexual orientation. Indirect benefits described by participants included perceptions of helping others and the larger gay community. Few participants described harms (discomfort recalling experiences). Our data suggest that participating in qualitative sexual health research focused on sexual orientation, sexual attraction, and early same-sex sexual experiences may result in minimal harms for YBMSM and multiple benefits, including feeling more comfortable than in a general medical visit.

Contributions of Qualitative Research in Informing HIV/AIDS Interventions Targeting Black MSM in the United States

This article presents a systematic review of qualitative studies focusing on human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among Black men who have sex with men (BMSM) in the United States. We reviewed studies that were published between 1980 and 2014. Qualitative methods employed in the studies reviewed include in-depth interviews, focus groups, participant observation, and ethnography. We searched several databases (PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar) for relevant articles using the following broad terms: "Black men" "Black gay/bisexual" or "Black men who have sex with men," and "qualitative" and/or "ethnography." We include 70 studies in this review. The key themes observed across studies were (1) heterogeneity, (2) layered stigma and intersectionality, (3) risk behaviors, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that sexual behavior and HIV-status disclosure, sexual risk taking, substance use, and psychological well-being were contextually situated. Interventions occurring at multiple levels and within multiple contexts are needed to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve the health outcomes among BMSM. Community engagement and using community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.

Exploring sexual health among young Black men who have sex with men in New York City

Young Black men who have sex with men (YBMSM) account for approximately 10% of the total HIV infection in the United States but represent <1% of the population. Few interventions exist that address their unique needs, and those that do adopt a narrow, risk-based framework for prevention. Qualitative data from the Brothers Connect Study were analyzed to explore how a Sexual Health Model (SHM) developed by Robinson et al. (The sexual health model: application of a sexological approach to HIV prevention. Health Educ Res 2002; 17:43-57) could be used as a framework for HIV prevention in YBMSM. Content analysis identified five key themes within SHM: (i) race/ethnicity, including the cultural diversity and unique challenges of YBMSM; (ii) disclosure, as the ongoing process of self-identification rather than a single instance of 'coming out'; (iii) sex, in terms of practices, behaviors and health; (iv) daily challenges, microaggressions and acute instances of discrimination; and (v) the self, resilience and identity. Technology represents a new component for the SHM that may be relevant to YBMSM. YBMSM are in need of comprehensive sexual health programs that go beyond typical HIV frameworks. A tailored SHM could be used for identifying and addressing the specific sexual health needs of YBMSM in research and intervention.

Exploring Service Provider Perceptions of Treatment Barriers Facing Black, Non-Gay-Identified MSMW

Non-gay-identified men who have sex with men and women and who use alcohol and other drugs are a vulnerable population. Little is known about health and medical service provider interaction with these underserved clients. This article presents a thematic analysis of two focus groups undertaken with social and medical service providers regarding the needs of non-gay-identified men who have sex with men and women. Four emergent themes (labeling, constructions of masculinity, HIV/AIDS awareness, and treatment success) illustrate perceived barriers to HIV/AIDS prevention and treatment, as well as treatment success. Implications for policy, practice, and future research are discussed.

Keeping gay and bisexual men safe: The arena of HIV prevention science and praxis

Abstract In this article, I draw from an ongoing ethnographic study of HIV prevention for gay, bisexual, and 'men who have sex with men' to develop an institutional analysis of HIV behavioral intervention science and praxis. I approach this analysis through the lens of the social worlds framework, focusing on the institutional arena in which HIV behavioral interventions are devised and executed. Toward this end, I focus on two fundamental points of contention that lie at the heart of the prevention enterprise and put its social organization in high relief: (1) conceptions of health and lifestyle practices and (2) attributions of expertise. These core contentions reveal less the steady advance of normal science than an arena of actors ensconced in boundary work and jurisdictional struggles over how to engineer behavior change and reduce the scale of the HIV epidemic. Their resolution, I argue, has occurred in a historically contingent process determined by the political economy of the US HIV prevention arena and the differential structural location of its social worlds.

Thriving and Adapting: Resilience, Sense of Community, and Syndemics among Young Black Gay and Bisexual Men

We examined resilience associated with the avoidance of psychosocial health conditions (i.e., syndemics) that increase vulnerability for HIV among young Black gay and bisexual men. We used analytic induction to compare a sample of 23 men who showed no evidence of syndemic conditions to a sample of 23 men who experienced syndemic conditions. The men who avoided syndemics reported supportive relationships with people who helped them to develop a strong sense of identity, provided them with opportunities to give back to their communities, and promoted positive norms about health. In contrast, the men experiencing syndemic conditions described numerous instances of trauma and oppression that infringed upon their desire to form positive relationships. Among these men, experiences of oppression were associated with shame, identity incongruence, social isolation, relational disconnection, mistrust of men, and expectations of further marginalization. We examined participants' experiences through the framework of the psychosocial sense of community. Results of this study provide evidence for using strength-based intervention strategies to prevent syndemic conditions. Findings suggest that to attenuate socio-structural barriers to health and comorbid psychosocial health concerns, interventions must address young men's social isolation and promote positive identity and sense of community.

Psychosocial Implications of Homophobia and HIV Stigma in Social Support Networks: Insights for High-Impact HIV Prevention Among Black Men Who Have Sex With Men

Black men who have sex with men (BMSM) bear an increasingly disproportionate burden of HIV in the United States. The Centers for Disease Control and Prevention recommends high-impact combination prevention for populations at high risk for HIV infection, such as BMSM. However, few scholars have considered the types of behavioral interventions that combined with biomedical prevention could prove effective for mitigating the epidemic among BMSM. Between June 2013 and May 2014, we conducted three in-depth interviews each with 31 BMSM, interviews with 17 community stakeholders, and participant observation in New York City to understand the sociocultural and structural factors that may affect the acceptance of and adherence to oral preexposure prophylaxis among BMSM and to inform an adherence clinical trial. BMSM and community leaders frequently described condomless sex as a consequence of psychosocial factors and economic circumstances stemming from internalized homophobia resulting from rejection by families and religious groups. BMSM revealed that internalized homophobia and HIV stigma resulted in perceived lack of self- and community efficacy in accepting and adhering to preexposure prophylaxis. Our results indicate that addressing internalized homophobia and fostering emotional social support in peer networks are key elements to improve the effectiveness of combination prevention among BMSM.

Engineering behaviour change in an epidemic: the epistemology of NIH-funded HIV prevention science

Social scientific and public health literature on National Institutes of Health-funded HIV behavioural prevention science often assumes that this body of work has a strong biomedical epistemological orientation. We explore this assumption by conducting a systematic content analysis of all NIH-funded HIV behavioural prevention grants for men who have sex with men between 1989 and 2012. We find that while intervention research strongly favours a biomedical orientation, research into the antecedents of HIV risk practices favours a sociological, interpretive and structural orientation. Thus, with respect to NIH-funded HIV prevention science, there exists a major disjunct in the guiding epistemological orientations of how scientists understand HIV risk, on the one hand, and how they engineer behaviour change in behavioural interventions, on the other. Building on the extant literature, we suggest that the cause of this disjunct is probably attributable not to an NIH-wide positivist orientation, but to the specific standards of evidence used to adjudicate HIV intervention grant awards, including randomised controlled trials and other quantitative measures of intervention efficacy.

The Role of Resilience and Anti-Resilience Behaviors in the Romantic Lives of Black Same Gender Loving (sgl) Men

This study examines the role of resilience in the romantic lives of Black same gender loving romantic male couples in the nyc metropolitan area. Twenty in-depth interviews (N=40) were conducted, ranging in age from 18 to 67, and were predominately low income and moderately educated. Research questions were: 1) What strategies do Black sgl couples use to preserve and improve their relationships and (2) What are the potential problems or barriers your relationship experiences? The data from interviews were aggregated and three major themes emerged: direct communication strategies, relationship support, and intentional and thoughtful decision making. Additional themes identified as anti-resilient to Black sgl couples were relationship discord, hostile neighborhood climate, poor communication, and lack of support. Findings show that additional research Black gay couples is needed to identify the contextual factors that influence their romantic relationships and the resilient strategies that they uses to support their romantic relationships.

Engaging, recruiting, and retaining black men who have sex with men in research studies: don't underestimate the importance of staffing--lessons learned from HPTN 061, the BROTHERS study

CONTEXT

HIV/AIDS in the United States continues to primarily impact men who have sex with men (MSM), with disproportionately high rates among black MSM.

OBJECTIVE

The purpose of this study was to identify factors that may influence engagement and retention of black MSM in HIV research.

DESIGN AND PARTICIPANTS

This was a qualitative evaluation of study implementation within a multisite, prospective, observational study (HIV Prevention Trials Network 061, BROTHERS) that enrolled 1553 black MSM in 6 cities throughout the United States. Data collection for this evaluation included a written, structured survey collected from each of the sites describing site characteristics including staff and organizational structure, reviews of site standard operating procedures, and work plans; semistructured key informant interviews were conducted with site coordinators to characterize staffing, site-level factors facilitating or impeding effective community engagement, study recruitment, and retention. Data from completed surveys and site standard operating procedures were collated, and notes from key informant interviews were thematically coded for content by 2 independent reviewers.

RESULTS

Several key themes emerged from the data, including the importance of inclusion of members of the community being studied as staff, institutional hiring practices that support inclusive staffing, cultivating a supportive working environment for study implementation, and ongoing relationships between research institutions and community.

CONCLUSIONS

This study underscores the importance of staffing in implementing research with black MSM. Investigators should consider how staffing and organizational structures affect implementation during study design and when preparing to initiate study activities. Ongoing monitoring of community engagement can inform and improve methods for engagement and ensure cultural relevance while removing barriers for participation.

Opportunities for improving partner notification for HIV: results from a community-based participatory research study

To identify actionable opportunities for improving Partner Notification (PN) for HIV among men who have sex with men (MSM), we characterized the perspectives and experiences of PN among Medical Case Managers (case managers), Disease Intervention Specialists (DIS), and MSM. In partnership with an AIDS service organization and the Connecticut State Health Department, we conducted a focus group of case managers (n = 14) and in-depth interviews with DIS (n = 7) and MSM (n = 24). We found differences between MSM's and providers' (case managers and DIS) perspectives regarding (1) determinants of sexual risk behaviors; (2) considerations impacting HIV disclosure; and (3) barriers to trusting relationships between MSM and providers. Factors impacting MSM perspectives on PN were incompletely appreciated by both case managers and DIS. PN may be improved through improving provider understanding of the complexities for MSM regarding sexual risk behaviors and disclosure and transcending barriers to trusting relationships between MSM and providers.

Discussion of HIV status by serostatus and partnership sexual risk among internet-using MSM in the United States

Men who have sex with men (MSM), particularly black MSM, are disproportionally infected with HIV. Little is known about how discussion of HIV status between partners varies among MSM by race/ethnicity and by HIV transmission risk. Among a national survey of 2031 MSM reporting 5410 partnerships, black MSM, especially black HIV-positive MSM, serodiscussed with unprotected anal intercourse partners less than did white MSM. Although non-black HIV-positive, non-black HIV-negative MSM, and black HIV-negative MSM were more likely to report serodiscussion with unprotected anal intercourse partners, black HIV-positive MSM were not. Differential serodiscussion may play a role in explaining the racial/ethnic disparity in HIV incidence.

Ideologies of Black churches in New York City and the public health crisis of HIV among Black men who have sex with men

Black men who have sex with men (MSM) are disproportionately affected by HIV and AIDS in New York City (NYC). Black churches in NYC have a history of engaging in community mobilisation; however, research suggests that churches play a role in promoting stigma against Black MSM, which impedes prevention efforts. The goal of this study was to explore church ideologies surrounding sexuality and health, and the relationship of these ideologies to church mobilisation in response to HIV/AIDS among Black MSM. We conducted interviews and focus groups with pastors and parishioners at Black churches in NYC. Three prominent themes were identified: (1) 'Love the sinner, hate the sin'--distinguishing behaviour and identity; (2) 'Don't ask, don't tell'--keeping same-sex behaviour private; and (3) 'Your body is a temple'--connecting physical and spiritual health. We discuss the implications of these ideologies for church mobilisation and HIV prevention efforts. In doing so, we pay close attention to how ideologies may both impede and facilitate church dialogue around sexuality and heightened responses to the HIV crisis affecting Black MSM.