Straight Talk: Development of an HIV Prevention Intervention Designed for Heterosexual, African American Men

Background: Few HIV prevention interventions designed for heterosexual, African American men exist. The purpose of this paper is to describe the process of designing a behavioral HIV prevention intervention for heterosexual, African American men living in high HIV prevalence areas of New York City. Methods: Informed by a formative research phase (5 focus groups; 30 qualitative, in-depth interviews; 61 quantitative interviews), we developed a matrix linking social, personal and behavioral factors with study outcomes (condom use, concurrent partnering, and HIV testing). In partnership with a team of community experts, we developed intervention modules; then, we conducted component testing (n=8) and a pre-pilot (n=7) of the resultant 4-session group intervention, observed by study team members. We held group interviews with participants to receive feedback and identify strengths and weaknesses of the intervention and subsequently revised the intervention, based on this feedback. Results: This resulted in an intervention framed by social cognitive theory, integrating elements of empowerment, rational choice/cognitive behavioral and masculinity/identity theories. Content includes basic HIV education and skills, cognitive-behavioral condom use negotiation with primary partner modules, social and personal identity-based modules on fatherhood and racial identity, and empowerment-based modules addressing social determinants of health. Observations and participant interviews resulted in removal of select analytic modules, increased content emphasis on communication and HIV testing and greater focus on racial identity-related modules. Conclusion: We developed a behavioral intervention that may be acceptable and feasible for African American, heterosexual men. A pre/post-test pilot study among 50 men with 3-month follow-up outcomes is ongoing.