International AIDS Society


Risk Program Works for US Black Men Who Have Sex With Men, Women

Author: Mark Mascolini


09 September 2013

A multisession small-group intervention lowered risk behavior with women among African-American men who have sex with men and women (MSMW), according to results of a randomized trial involving almost 300 men.

Young black men in the United States account for a large proportion of new HIV infections. Many US black men who have sex with men also have sex with women. But these MSMW may not respond to risk-reduction interventions designed for men who identify themselves as gay. Therefore researchers devised and tested an intervention specifically for black MSMW.

Men of African American Legacy Empowering Self (MAALES) is a multisession, small-group intervention “designed to build skills, address sociocultural issues, and reduce risk behaviors in black MSMW.” Researchers recruited 437 black MSMW from 2007 to 2011 and randomized them to MAALES or to a control intervention—a single, one-on-one HIV risk-reduction session.

Study participants answered surveys at study entry and 3 and 6 months after they completed the intervention. The researchers used multiple regression analysis to compare risk behaviors before and after the intervention. This analysis adjusted for baseline risk behaviors, time between assessments, other covariates, and clustering.

More than half of study participants (55%) had a monthly income below $1000, and nearly half had already tested positive for HIV infection. Among randomized participants, 291 completed at least one follow-up visit.

Adjusted analysis determined that, compared with the control intervention, MAALES was associated with nearly a 40% reduction in number of total anal or vaginal sex acts (risk ratio [RR] 0.61, 95% confidence interval [CI] 0.49 to 0.76).

MAALES halved the number of unprotected (condom-free) sex acts with all women (RR 0.50, 95% CI 0.37 to 0.66) and nearly halved the number of unprotected sex acts with female partners (RR 0.56, 95% CI 0.44 to 0.72). MAALES also reduced the number of male intercourse partners, but not significantly more than the control intervention.

The researchers conclude that “the MAALES intervention was efficacious at reducing HIV risk behaviors in black MSMW.”

Source: Nina T. Harawa, John K. Williams, W.J. McCuller, Hema C. Ramamurthi, Martin Lee, Martin F. Shapiro, Keith C. Norris, William E. Cunningham. Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men: results of a randomized trial. AIDS. 2013; 27: 1979-1988.

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