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Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men: results of a randomized trial

Harawa, Nina T.a; Williams, John K.b; McCuller, W.J.a; Ramamurthi, Hema C.a; Lee, Martina; Shapiro, Martin F.c; Norris, Keith C.a; Cunningham, William E.c

doi: 10.1097/QAD.0b013e3283617500
Epidemiology and Social

Objectives: Black men who have sex with men and women (MSMW) experience high HIV rates and may not respond to interventions targeting gay-identified men. We tested the efficacy of the Men of African American Legacy Empowering Self (MAALES), a multisession, small-group holistically framed intervention designed to build skills, address sociocultural issues, and reduce risk behaviors in black MSMW.

Design: From 2007 to 2011, we enrolled 437 black MSMW into a parallel randomized controlled trial that compared MAALES to the control condition, a single, individualized HIV risk-reduction session.

Methods: Participants completed surveys at baseline, 3 months, and 6 months postintervention. We used multiple regressions to compare risk behaviors at follow-up between the intervention and control groups while adjusting for baseline risk behaviors, time between assessments, other covariates, and clustering. We used inverse probability weighting (IPW) to adjust for loss-to-follow-up while carrying out these regressions with the 291 (76.4%) randomized participants who completed at least one follow-up.

Results: Participants were largely low-income (55% reported monthly incomes <$1000); nearly half had previously tested HIV positive. At 6 months of follow-up, unadjusted within-group analyses demonstrated reduced risk behaviors for the MAALES but not the control group. Adjusted results indicated significant intervention-associated reductions in the numbers of total anal or vaginal sex acts [risk ratio = 0.61; 95% confidence interval (CI) 0.49–0.76], unprotected sex acts with women (risk ratio = 0.50; 95% CI 0.37–0.66), and female partners (risk ratio = 0.56; 95% CI 0.44–0.72). Near significant reductions were observed for number of male intercourse partners.

Conclusion: The MAALES intervention was efficacious at reducing HIV risk behaviors in black MSMW.

aDepartment of Research/Life Sciences Institute, College of Medicine, Charles R. Drew University of Medicine and Science (CDU)

bDepartment of Psychiatry and Biobehavioral Sciences

cDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA.

Correspondence to Nina T. Harawa, MPH, PhD, Charles R. Drew University, Los Angeles, California, USA. E-mail:

Received 1 August, 2012

Revised 6 March, 2013

Accepted 20 March, 2013

© 2013 Lippincott Williams & Wilkins, Inc.