Abstract
BackgroundHuman immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM.ObjectiveThe objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices.MethodsThe study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of care control condition), and completed a 10-minute user-satisfaction survey. Six months later, participants from both conditions returned to complete the follow-up assessment.ResultsA total of 226 participants were enrolled in the study, and 144 completed the 6-month follow-up. Real Talk participants were more likely to disagree that they had intended in the last 6 months to bottom without a condom with a partner of unknown status (mean difference=−0.608, P=.02), have anal sex without a condom with a positive man who was on HIV medications (mean difference=−0.471, P=.055), have their partner pull out when bottoming with a partner of unknown HIV status (mean difference=−0.651, P=.03), and pull out when topping a partner of unknown status (mean difference=−0.644, P=.03). Real Talk participants were also significantly more likely to disagree with the statement “I will sometimes lie about my HIV status with people I am going to have sex with” (mean difference=−0.411, P=.04). In terms of attitudes toward HIV prevention, men in the control group were significantly more likely to agree that they had less concern about becoming HIV positive because of the availability of antiretroviral medications (mean difference=0.778, P=.03) and pre-exposure prophylaxis (PReP) (mean difference=0.658, P=.05). There were, however, no significant differences between Real Talk and control participants regarding actual condom use or other risk reduction strategies.ConclusionsOur findings suggest that Real Talk supports engagement on HIV prevention issues. The lack of behavior findings may relate to insufficient study power or the fact that a 2-hour, standalone intervention may be insufficient to motivate behavioral change. In conclusion, we argue that Real Talk’s modular format facilitates its utilization within a broader array of prevention activities and may contribute to higher PReP utilization in black MSM communities.
Highlights
BackgroundHuman immunodeficiency virus (HIV) has disproportionately affected black men who have sex with men (MSM) since the beginning of the epidemic
Our findings suggest that Real Talk supports engagement on HIV prevention issues
In comparision with the control group condition, Real Talk participants were more likely to disagree that they had intended in the last 6 months to bottom without a condom with a partner of unknown status, have their partner pull out when bottoming with a partner of unknown HIV status, and pull out when topping a partner of unknown status, and have anal sex without a condom with a positive man who was on HIV medications approached significance
Summary
BackgroundHuman immunodeficiency virus (HIV) has disproportionately affected black men who have sex with men (MSM) since the beginning of the epidemic. Since 2014, black MSM have been the subpopulation with the highest number of new HIV diagnoses [3], and a recent meta-analysis estimated black MSM incidence rates at 4.16% [4] If these trends continue, 50% to 60% of black gay and bisexual men will receive an HIV diagnosis in their lifetime, nearly 3 times the percentage of gay and bisexual men overall [3,4]. Nor are there any demonstrated efficacious technology-delivered interventions targeting black MSM, despite the growth of effective eHealth and mHealth sexual health programs in recent years [6]. The authors created Real Talk, a technology-delivered, sexual health program for black MSM
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