Using a community-based participatory approach to understand social, cultural and psychological factors that influence HIV risk among African American heterosexually active college men

Background: African American males are disproportionately affected by HIV/AIDS. In North Carolina, black men have six times the rate of infection among white men. NC is experiencing a sharp increase in HIV infections among young African American men, and a focus of the outbreak is on college campuses. Methods: We conducted formative research on a college campus to inform the design of an HIV risk-reduction intervention. Community-based participatory research was used. 120 men were recruited, using online and campus-based strategies. Participants completed a brief risk survey, with 47 participating in five focus groups, and 20 in individual interviews. Results: Survey data identify four independent factors associated with using condoms in the past 3 months: younger age (p<.01); living on campus (p<.003); not having a primary partner (p<.001); and decreased alcohol (p<.002) and drug use (p<.001). Focus group and interview data revealed influences on risk for HIV: how men define sex and sexual risk; relationship challenges to honest dialogue about sex; and the importance of masculine and sexual reputation in a college setting. Conclusion: Findings suggest HIV efforts should focus on students who are older, live off campus, use alcohol and drugs, and have primary sexual partners. In addition to basic HIV and sexual health information, HIV interventions tailored for this population should address cultural definitions of sex, ideas of protection, sexual communication and ways men negotiate their masculinity that contribute to risk. We used these results to develop an HIV risk-reduction intervention for heterosexually active African American college men.