Preliminary Findings of a Technology-Delivered Sexual Health Promotion Program for Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study

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.

A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men

“…None of significant differences were found between both intervention and control groups in terms of sexual risk behaviours. However, the authors reported a higher likelihood of intention in using condom and motivating HIV testing in the intervention group than that in the control group [87].…”

“…Sexual risk behaviors were the most common primary outcomes (n = 32 studies), following by HIV/STI testing and self-testing (n = 18 studies) and HIV/STI disclosure, stigma, self-esteem, and internalized homonegativity (n = 9 studies). Several studies focused on HIV/STI prevention knowledge and attitudes [47,56,67,86,87], HIV disclosure [60,62,79,[87][88][89], gonorrhea and chlamydial infection and treatment [90], or pre-exposure prophylaxis uptake [57,91] and adherence [92,93]. Reback et al (2012) had an additional outcome regarding the frequency of methamphetamine use among MSM [50], and Hightow-Weidman et al (2019) investigated the intention to use a condom, attitudes toward safe sexual behaviours, condom use self-efficacy, depressive symptoms, social support and social isolation [49].…”

“…Meanwhile, Klein et al's quasi-experiment study concentrated on risk behaviours (substance use and sexual practices) reduction, inter-sectionalities, and HIV/STIs prevention knowledge and attitude among Black MSM [87]. This study applied the Social Cognitive theory alone [87].…”

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean

“…Stigma-focused interventions have generally been delivered in-person; while demonstrating efficacy, these interventions have been implemented on a relatively small scale (177). HIV prevention interventions that include Black MSM have included stigma as an intervention topic (178)(179)(180) and a growing number of eHealth interventions have been developed for Black MSM (178,181,182) but few interventions have addressed intersectional stigma (169,183). To date, there are few effective interventions for cis-gender, gay or bisexual FB Black Caribbean immigrant men to promote HIV testing (18).…”

“…HIV prevention interventions that include Black MSM have included stigma as an intervention topic (178)(179)(180) and a growing number of eHealth interventions have been developed for Black MSM (178,181,182), but few interventions have addressed intersectional stigma (169,183). Stigma-focused interventions have generally been delivered in-person and have been implemented on a relatively small scale (177).…”