On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial

Abstract

We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk-reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV-diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk-reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention, immediately post-intervention, and 6 and 12 months post-intervention surveys. Of 595 participants, 503 (85 %) completed the 12-month follow-up. Generalized-estimating-equations analysis indicated that, compared with the attention-matched control intervention, the BRO intervention did not increase consistent condom use averaged over the 6- and 12-month follow-ups, which was the primary outcome. Although BRO did not affect the proportion of condom-protected intercourse acts, unprotected sexual intercourse, multiple partners, or insertive anal intercourse, it did reduce receptive anal intercourse compared with the control, a behavior linked to incident HIV infection. Mediation analysis using the product-of-coefficients approach revealed that although BRO increased seven of nine theoretical constructs it was designed to affect, it increased only one of three theoretical constructs that predicted consistent condom use: condom-use impulse-control self-efficacy. Thus, BRO indirectly increased consistent condom use through condom-use impulse-control self-efficacy. In conclusion, although BRO increased several theoretical constructs, most of those constructs did not predict consistent condom use; hence, the intervention did not increase it. Theoretical constructs that interventions should target to increase African American MSM’s condom use are discussed.

Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial

“…In the mediation analyses, Model 1 (χ 2 [28]=98.95, p < .001; CFI = 0.96; TLI = 0.92; RMSEA = 0.05 [90% CI: 0.037 - 0.057]; SRMR = 0.06) and Model 2 (χ 2 [29] = 101.14, p < .001; CFI = 0.96; TLI = 0.92; RMSEA = 0.05 [90% CI: 0.04 - 0.06]; SRMR = 0.06) had acceptable model fit indices. [44, 45] Model 1 did not fit the data better than Model 2, the simplified model, TRd = 0.82, p = .366; hence, being parsimonious, Model 2 is the better model.…”

“…The eligibility criteria were based on the HIV/STI risk-reduction intervention, which was the primary intervention the study was funded to test. [28] Men were eligible if they were at least 18 years of age, self-identified as Black or African American, were born a male, and reported having anal intercourse with a man in the past 90 days. Eligible participants were invited to participate in “Project Being Responsible for Ourselves” (BRO) designed to reduce health risks, including cardiovascular diseases, cancers, and STIs, including HIV.…”

“…[30] It was structurally similar, containing activities similar to the physical-activity intervention but focused on reducing sexual-risk behaviors. [28]…”

“…An a priori statistical power analysis, described elsewhere,[28] was performed to determine sample size to test the HIV risk-reduction intervention's efficacy, which was the primary purpose of the trial. Using the sample size ( N = 594) that power analysis suggested and assuming a two-tailed test, α = .05, and 20% attrition, the estimated power is 80% to detect a Cohen's d = 0.25 difference in the physical-activity intervention compared with the control intervention.…”

Neighborhood Crime and Sexual Transmission Risk Behavior among Black Men Living with HIV

“…Studies have been undertaken to develop appropriate behavioral and psychosocial interventions to mitigate HIV risk among the most vulnerable population, Black men who have sex with men. 49–52 However, addressing this syndemic requires a multidisciplinary approach including structural interventions. Structural interventions promote health by altering the environment within which health is produced and reproduced and can include programs as well as policy initiatives.…”