Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men: Results of a randomized trial

Nina T. Harawa, John K. Williams, W. J. McCuller, Hema C Ramamurthi, Martin Lee, Martin F. Shapiro, Keith C. Norris, William E. Cunningham

Research output: Contribution to journalArticle

Abstract

Objectives: Black men who have sex with men and women (MSMW) experience high HIV rates and may not respond to interventions targeting gay-identified men. We tested the efficacy of the Men of African American Legacy Empowering Self (MAALES), a multisession, small-group holistically framed intervention designed to build skills, address sociocultural issues, and reduce risk behaviors in black MSMW. Design: From 2007 to 2011, we enrolled 437 black MSMW into a parallel randomized controlled trial that compared MAALES to the control condition, a single, individualized HIV risk-reduction session. Methods: Participants completed surveys at baseline, 3 months, and 6 months postintervention. We used multiple regressions to compare risk behaviors at follow-up between the intervention and control groups while adjusting for baseline risk behaviors, time between assessments, other covariates, and clustering. We used inverse probability weighting (IPW) to adjust for loss-to-follow-up while carrying out these regressions with the 291 (76.4%) randomized participants who completed at least one follow-up. Results: Participants were largely low-income (55% reported monthly incomes <$1000); nearly half had previously tested HIV positive. At 6 months of follow-up, unadjusted within-group analyses demonstrated reduced risk behaviors for the MAALES but not the control group. Adjusted results indicated significant intervention-associated reductions in the numbers of total anal or vaginal sex acts [risk ratio=0.61; 95% confidence interval (CI) 0.49-0.76], unprotected sex acts with women (risk ratio=0.50; 95% CI 0.37-0.66), and female partners (risk ratio=0.56; 95% CI 0.44-0.72). Near significant reductions were observed for number of male intercourse partners. Conclusion: The MAALES intervention was efficacious at reducing HIV risk behaviors in black MSMW.

Original languageEnglish (US)
Pages (from-to)1979-1988
Number of pages10
JournalAIDS
Volume27
Issue number12
DOIs
StatePublished - Jul 31 2013
Externally publishedYes

Fingerprint

Risk Reduction Behavior
Risk-Taking
HIV
African Americans
Odds Ratio
Confidence Intervals
Unsafe Sex
Control Groups
Sexual Minorities
Cluster Analysis
Randomized Controlled Trials

Keywords

  • African-Americans/ethnology/psychology
  • Bisexuality
  • Black/African-American
  • HIV infections/epidemiology/ethnology/ prevention & control
  • Homosexuality
  • Risk-reduction behavior

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men : Results of a randomized trial. / Harawa, Nina T.; Williams, John K.; McCuller, W. J.; Ramamurthi, Hema C; Lee, Martin; Shapiro, Martin F.; Norris, Keith C.; Cunningham, William E.

In: AIDS, Vol. 27, No. 12, 31.07.2013, p. 1979-1988.

Research output: Contribution to journalArticle

Harawa, NT, Williams, JK, McCuller, WJ, Ramamurthi, HC, Lee, M, Shapiro, MF, Norris, KC & Cunningham, WE 2013, 'Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men: Results of a randomized trial', AIDS, vol. 27, no. 12, pp. 1979-1988. https://doi.org/10.1097/QAD.0b013e3283617500
Harawa, Nina T. ; Williams, John K. ; McCuller, W. J. ; Ramamurthi, Hema C ; Lee, Martin ; Shapiro, Martin F. ; Norris, Keith C. ; Cunningham, William E. / Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men : Results of a randomized trial. In: AIDS. 2013 ; Vol. 27, No. 12. pp. 1979-1988.
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abstract = "Objectives: Black men who have sex with men and women (MSMW) experience high HIV rates and may not respond to interventions targeting gay-identified men. We tested the efficacy of the Men of African American Legacy Empowering Self (MAALES), a multisession, small-group holistically framed intervention designed to build skills, address sociocultural issues, and reduce risk behaviors in black MSMW. Design: From 2007 to 2011, we enrolled 437 black MSMW into a parallel randomized controlled trial that compared MAALES to the control condition, a single, individualized HIV risk-reduction session. Methods: Participants completed surveys at baseline, 3 months, and 6 months postintervention. We used multiple regressions to compare risk behaviors at follow-up between the intervention and control groups while adjusting for baseline risk behaviors, time between assessments, other covariates, and clustering. We used inverse probability weighting (IPW) to adjust for loss-to-follow-up while carrying out these regressions with the 291 (76.4{\%}) randomized participants who completed at least one follow-up. Results: Participants were largely low-income (55{\%} reported monthly incomes <$1000); nearly half had previously tested HIV positive. At 6 months of follow-up, unadjusted within-group analyses demonstrated reduced risk behaviors for the MAALES but not the control group. Adjusted results indicated significant intervention-associated reductions in the numbers of total anal or vaginal sex acts [risk ratio=0.61; 95{\%} confidence interval (CI) 0.49-0.76], unprotected sex acts with women (risk ratio=0.50; 95{\%} CI 0.37-0.66), and female partners (risk ratio=0.56; 95{\%} CI 0.44-0.72). Near significant reductions were observed for number of male intercourse partners. Conclusion: The MAALES intervention was efficacious at reducing HIV risk behaviors in black MSMW.",
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AU - Ramamurthi, Hema C

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N2 - Objectives: Black men who have sex with men and women (MSMW) experience high HIV rates and may not respond to interventions targeting gay-identified men. We tested the efficacy of the Men of African American Legacy Empowering Self (MAALES), a multisession, small-group holistically framed intervention designed to build skills, address sociocultural issues, and reduce risk behaviors in black MSMW. Design: From 2007 to 2011, we enrolled 437 black MSMW into a parallel randomized controlled trial that compared MAALES to the control condition, a single, individualized HIV risk-reduction session. Methods: Participants completed surveys at baseline, 3 months, and 6 months postintervention. We used multiple regressions to compare risk behaviors at follow-up between the intervention and control groups while adjusting for baseline risk behaviors, time between assessments, other covariates, and clustering. We used inverse probability weighting (IPW) to adjust for loss-to-follow-up while carrying out these regressions with the 291 (76.4%) randomized participants who completed at least one follow-up. Results: Participants were largely low-income (55% reported monthly incomes <$1000); nearly half had previously tested HIV positive. At 6 months of follow-up, unadjusted within-group analyses demonstrated reduced risk behaviors for the MAALES but not the control group. Adjusted results indicated significant intervention-associated reductions in the numbers of total anal or vaginal sex acts [risk ratio=0.61; 95% confidence interval (CI) 0.49-0.76], unprotected sex acts with women (risk ratio=0.50; 95% CI 0.37-0.66), and female partners (risk ratio=0.56; 95% CI 0.44-0.72). Near significant reductions were observed for number of male intercourse partners. Conclusion: The MAALES intervention was efficacious at reducing HIV risk behaviors in black MSMW.

AB - Objectives: Black men who have sex with men and women (MSMW) experience high HIV rates and may not respond to interventions targeting gay-identified men. We tested the efficacy of the Men of African American Legacy Empowering Self (MAALES), a multisession, small-group holistically framed intervention designed to build skills, address sociocultural issues, and reduce risk behaviors in black MSMW. Design: From 2007 to 2011, we enrolled 437 black MSMW into a parallel randomized controlled trial that compared MAALES to the control condition, a single, individualized HIV risk-reduction session. Methods: Participants completed surveys at baseline, 3 months, and 6 months postintervention. We used multiple regressions to compare risk behaviors at follow-up between the intervention and control groups while adjusting for baseline risk behaviors, time between assessments, other covariates, and clustering. We used inverse probability weighting (IPW) to adjust for loss-to-follow-up while carrying out these regressions with the 291 (76.4%) randomized participants who completed at least one follow-up. Results: Participants were largely low-income (55% reported monthly incomes <$1000); nearly half had previously tested HIV positive. At 6 months of follow-up, unadjusted within-group analyses demonstrated reduced risk behaviors for the MAALES but not the control group. Adjusted results indicated significant intervention-associated reductions in the numbers of total anal or vaginal sex acts [risk ratio=0.61; 95% confidence interval (CI) 0.49-0.76], unprotected sex acts with women (risk ratio=0.50; 95% CI 0.37-0.66), and female partners (risk ratio=0.56; 95% CI 0.44-0.72). Near significant reductions were observed for number of male intercourse partners. Conclusion: The MAALES intervention was efficacious at reducing HIV risk behaviors in black MSMW.

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