Laying the Groundwork for HIV Prevention: Understanding and Describing the Los Angeles House and Ball Communities

Background: African American young men who have sex with men (AAYMSM) represent the largest proportion of new infections among MSM. While evidence-based interventions are lacking, all too often HIV inteventions are implemented in a community without thoroughly understanding its needs, risks and assests. AAYMSM are not homogenous; subgroups exist that may require different methods/theoretical approaches to be effective. The House and Ball communities represent one such subgroup. Methods: A community-engaged, mixed-methods approach was used. Participant observations, qualitative interviews with House leaders (N=26), and a survey at House/Ball events (N=263) were completed. Results: Quantitative data broadly describe the community. For example: 69% of survey respondents identify as gay; 25% as bisexual (42% report attraction to men and women); 13% reported recent use of ecstasy (compared to 7% of a similarly-aged non-Ball AAYMSM sample), 11% recently participated in sex exchange (compared to 4% of non-Ball sample); 16% carried a weapon and 31% reported being in a physical fight in the last 3 months. The depth of qualitative data is key for intervention development. For example, community assets were identified (e.g., “family” support, recognition, validation, safe space to be “themselves”). Challenges/needs were also identified (e.g., maintaining intimate relationships, discrimination from non-Ball AAYMSM, perceptions of Ball scene as “messy”). Conclusions: This kind of rigorous study is recommended prior to implementing an intervention. A mixed-methods design allows us to fully understand a community and develop appropriate interventions. Findings are discussed in relation to leveraging the communities' supportive aspects to design culturally relevant HIV prevention programs.