HIV Prevention for High Risk African American Young Men

The overarching aim is to develop a culturally tailored and developmentally appropriate HIV prevention intervention for African American young men who have sex with men (AAYMSM), ages 18 to 24 years. No group is at greater risk for acquiring HIV than YMSM, especially those living in inner cities, with AAYMSM now accounting for the largest number of new HIV infections detected in cities each year. If these trends continue, it is estimated that as many as 1 in 2 AAYMSM will be diagnosed with HIV in their lifetime.

The investigators propose to further refine and pilot test an intervention, called Young Men's Adult Identity Mentoring (YM-AIM). Adapted from an existing CDC Diffusing Effective Behavioral Intervention (DEBI), YM-AIM is a theory-driven, group-level intervention designed to help AAYMSM develop a healthy vision for their future (or "possible future self") by defining a set of short- and long-term goals in the areas of education, health, family and intimate relationships. Through the facilitated activities, participants consider how their involvement in risky behaviors (e.g., illicit drug use, condomless sex, multiple sex partners) would interfere with achieving those goals. With funding from NIDA (R21 DA024588), the investigators developed YM-AIM in response to findings from our own research, as well as those reported in the literature, which demonstrate that experiences of minority stress (e.g., racism, homophobia) and exposure to violence and victimization (family, intimate partner, community) put AAYMSM at significantly greater risk for illicit drug use, HIV/STI sexual risk (condomless anal sex), and mental health problems (e.g., depression) as compared to Caucasian and Hispanic/Latino YMSM.

During our initial pilot, participants (n=36) were enormously enthusiastic about their participation in YM-AIM (all participants attended all six weekly sessions), they provided positive feedback about the various components, activities, and exercises, and they reported that YM-AIM should continue to be delivered using a group-based intervention because they enjoyed the support provided by other group members. Participants also reported they wanted (and needed) ongoing social support after completing the intervention, to help them achieve their short- and long-term goals and maintain positive changes in sexual risk behaviors. This feedback is consistent with the literature that suggests mentors are immensely beneficial, particularly for youth and young adults, because they can share their worldviews, experiences, knowledge, support and advice, as well as provide a positive influence. By introducing youth to new experiences and sharing positive values, mentors can help young people avoid negative behaviors and achieve success. Having a mentor has also been found to reduce youths' risk for delinquency, aggression and drug use and lead to increased academic satisfaction and performance. Based on this, the investigators propose to further strengthen and refine YM-AIM by adding a youth mentoring/support component, called Youth Initiated Mentoring (YIM). YIM uses a positive youth development framework to help young, low-income ethnic/racial minorities: a) build social capital to achieve immediate and long-term life goals, b) build social support networks, c) identify and engage natural mentors in their networks to address structural barriers encountered in their lives, and d) develop relationships with supportive adults.

YM-AIM was developed in 2011, before widespread availability of PrEP/PEP. The investigators are therefore also proposing to add three new components: 1) biomedical HIV prevention strategies (PrEP, PEP), 2) HIV/STI testing and treatment referral, and 3) drug screening and treatment referral. This new intervention, which is called Y2Prevent, will then be evaluated for its feasibility and acceptability. Intervention outcomes include drug use in past 30 days and 3 months, alcohol use, condomless sex, number of partners, condom use intention, condom use self-efficacy, HIV testing recency/frequency, and linkage to care. The specific aims are to:

SPECIFIC AIM 1: Conduct formative research to develop Y2Prevent and refine our assessment measures.