Straight Talk: Results from Formative Research to Develop an HIV Prevention Intervention for Heterosexual, African American Men

Background: African American men comprised 55% of new, heterosexually acquired HIV/AIDS cases among men in the New York City in 2008. Few HIV prevention interventions exist for African American heterosexual men. Methods: To inform the design of an intervention, we conducted 5 focus groups (N=35), 30 qualitative and 61 quantitative interviews with men residing in two neighborhoods with high HIV prevalence (8-21%) among African American men. Descriptive analyses of quantitative data were conducted. Qualitative groups/interviews were transcribed verbatim, summative digests developed, and interviews coded using standard methods; a thematic analysis was conducted. Results: Participants' mean age was 33 (sd=7.9); 31% had less than high school education; 62% were unemployed and had less than $10,000 annual income; 85% reported lifetime history of incarceration. Seventy percent had a primary partner; 86% did not use a condom with this primary partner in the past 3 months. Participants reported 2.8 (sd=5.8) sex partners (past 3 months), with whom 85% reported no condom use. Qualitative analyses revealed that most men had low levels of HIV knowledge; perceived little risk of HIV from female partners; described concurrent/multiple partnering as normative; and disliked condoms. Accounts of sexual partnering patterns revealed how socioeconomic factors, including couple-level economic interdependence, and fatherhood influence sexual risk behaviors. Conclusions: These data identified a need for an HIV prevention intervention focused on basic HIV knowledge, condom use barriers/skills, concurrent partnering, and correct/consistent HIV testing. The roles of economic oppression, partnerships, masculinity and fathers/fatherhood emerged as processes conditioning sexual risk behavior.