Community-engaged research to identify support and risk in the House and Ball communities

Background: African American young men who have sex with men (AAYMSM) represent the largest proportion of new infections among MSM. Though HIV prevention efforts using bar-settings or community-based organizations have been met with success, research indicates that many at-risk AAYMSM do not frequent these venues. Instead, AAYMSM may be reached through the House and Ball communities – communities with high HIV incidence rates. Methods: A community-engaged, mixed-methods approach was used to identify elements of support and risk within the Los Angeles Ballroom community. Participant observations, qualitative interviews with House leaders (N=26), and a quantitative survey at House/Ball events (N=252) were completed. Data will be used to develop interventions deisgned for and by the Ballroom community. Results: Survey results indicate that 85% of respondents identify as African American; 69% identify as gay and 25% as bisexual. Thirteen percent reported recent use of ecstasy (compared to 7% of a similarly-aged non-Ball AAYMSM sample) and 11% participated in sex exchange in the last three months (compared to 4% of other AAYMSM sample). Qualitative interviews revealed key features of support (e.g., family and support; acceptance; validation, recognition) and risk (e.g., members' struggle to maintain status in Ballroom scene; sex work; substance use; danger of becoming too involved in Ball community; perception and stigma of Ballroom scene within larger gay community) within these communities. Conclusions: House and Ball communities offer unique opportunities for HIV prevention and findings are discussed in relation to leveraging the communities' supportive aspects to design effective and relevant HIV prevention programs.