Recruitment Strategies to Engage African American Men in HIV Testing Randomized Controlled Trials in the Rural Southern United States

Abstract

f the estimated 1.1 million Americans living withHIVinfection, about 18% are unaware of their infec-tion (Centers for Disease Control and Prevention[CDC], 2012). Routine HIV testing can facilitateearly diagnosis and linkage to care for persons whomaybeunawareoftheirinfection,therebydecreasingunintended ongoing HIV transmission (CDC, 2011;Hall, Holtgrave & Maulsby, 2012). AfricanAmericans, especially men, are disproportionatelyrepresented among both persons living with HIVand persons unaware of their infection (CDC,2013). Increased HIV testing efforts are vital, androutine HIV testing has been recommended by theCDC and the United States Preventive ServicesTask Force (CDC, 2006; Chou et al., 2012).For manyAfrican Americans inthe southern UnitedStates, the challenges of HIV-related stigma, racism,and distrust (both historical and institutional), poverty,and decreased health care access often make seekingand utilizing routine HIV testing and/or care attraditional health venues a challenge, especially inrural areas (Adimora, Ramirez, Schoenbach, C Prejean, Tang, & Hall, 2013). In ruralnorthern Florida, where African Americans aredisproportionately affected by high rates of HIV(Figure 1), conducting research to better understandhow to best develop and deliver HIV services is a vitalpart of reducing the burden of HIV. Community-basedtesting approaches that bring services to people wherethey live, work, and play could increase HIV testing ofat-risk populations in the rural south. Research isneeded to identify effective means of increasing HIVtesting among southern rural African American menas part of our national HIV prevention strategy(Office of National AIDS Policy, 2010).Historically, recruiting African Americans intoresearch studies, including randomized controlledtrials, has been a challenge for reasons includingdistrust of researchers and the research process,geographical distance from research sites, timeconstraints, and fear of being stigmatized (Corbie-Smith, Thomas, Williams, & Moody-Ayers, 1999;Polanco et al., 2011). Recruitment of certainsubpopulations, such as African American men andresidents of rural areas, into HIV prevention