Development of a barbershop-based HIV prevention intervention for adult black heterosexual men in Brooklyn, N.Y

Background: Heterosexual transmission is the second highest category for HIV infection among black men, yet few HIV prevention interventions exist for this population.

Methods:To inform intervention development, we conducted mixed methods research with 105 sexually active men ages 18-45 recruited from four Brooklyn, NY barbershops from 9/10-12/10. From high-risk sexual behaviors captured through audio computer-assisted structured interviews, we selected 21 men for 3 focus groups and 14 in-depth interviews. Questions focused on social, cognitive, and contextual factors linked with HIV risk. Qualitative data were transcribed, subjected to thematic analysis, and coded by 3-6 investigators.

Results: Sixty-two percent were US born; 28% were from the Caribbean. Half (52%) had ever been in jail/prison, and 27% were unemployed. Over the past 3 months, 78% reported a ‘main' female partner, 57% reported 2+ female partners, and 58% reported 1+ episode of unprotected vaginal/anal sex (UAVI) with female partners, 28% reported UAVI with 2+ women. Thematic analysis of qualitative data revealed UAVI is associated with lower HIV transmission knowledge and perceived risk, and higher emotional attachment/trust and heat of the moment/impulsive decision making. Additionally, most respondents expressed a strong desire to know more and to advocate for HIV prevention and to capitalize on their roles as protectors/caretakers in addressing HIV. They also spoke of the need to avoid reinforcement of stereotypes in intervention development.

Conclusions: Despite a high prevalence of high-risk sexual behaviors, adult black heterosexual men are eager to contribute to community health; this knowledge will inform HIV risk-reduction intervention development.