UNITED BLACK ELEMENT (U-BE) Adaptation of the Mpowerment Project to Young Black MSM Susan Kegeles Greg Rebchook John Peterson Robert Williams Dave Huebner Scott Tebbetts 2 Mpowerment Project United Black Element (U-BE): Adaptation of the Mpowerment Project to Young Black MSM Introduction This document discusses how the Mpowerment Project (MP) has been adapted to meet the HIV prevention needs and socio-cultural This document discusses context of YBMSM’s lives. When we first developed the MP, our intention was that it would be a “generic” program that would how the Mpowerment be tailored by each community that adopted the MP for its own Project (MP) has been unique culture, target population, and location. Some community- based organizations did just that. They examined the core adapted to meet the elements and principles that underlie the MP and adapted the HIV prevention needs MP for their populations (including YBMSM). Many other CBOs, and socio-cultural context however, wanted specific guidance about how to adapt the MP for their group, particularly for YBMSM. There was a strong feeling of YBMSM’s lives. among many people wanting to implement the MP that it needed to be broadened to include a focus on social forces and structural issues that affect YBMSM’s vulnerability to HIV transmission. This adaptation document represents the results of three research projects. Through these projects, we were able to incorporate input and experience from staff at a number of community-based organizations that focus on YBMSM (all of whom were Black gay/same gender loving men) and researchers at the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco (UCSF), the University of Utah, Georgia State University, and the Centers for Disease Control and Prevention. Input was also obtained from two advisory boards comprised of gay/same gender loving men. In addition, we were also able to obtain the input of young men themselves through six focus groups of YBMSM. Rather than being a theoretical discussion, this document focuses on how to operationalize the issues that need to be addressed in the intervention by focusing on the various core elements of the MP, as well as on the additional themes that arose. We discuss how to adapt each core element to make it more appropriate and relevant to the needs of YBMSM, and discuss the YBMSM-specific psychosocial and life context variables that we believe the adaptations address. We also discuss here some broader issues about how to approach behavior change with YBMSM using culturally relevant methods. 2 Mpowerment Project United Black Element (U-BE): Adaptation of the Mpowerment Project to Young Black MSM 3 Mpowerment Project United Black Element (U-BE): Adaptation of the Mpowerment Project to Young Black MSM This document should be used in tandem with the MP implementation manual (see mpowerment. org). We do not review here all parts of the MP, and many of the discussions here are based on the assumption that the reader already has an understanding of the core elements and guiding principles of the original MP (for more information about the core elements and guiding principles of MP, see Module 1: Overview of the Mpowerment Project manual at www.mpowerment.org). The first study we conducted was the Translation Project, which involved collaboration between researchers at the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco; staff from three Black community-based organizations (CBOs) and two advisory boards comprised of Black gay/same gender loving men. First, they considered if the MP, with its core elements and guiding principles, was relevant for YBMSM. Second, they reviewed each core element and guiding principle to give input about how to adapt them for YBMSM. Third, they gave advice about what issues they felt needed to be incorporated into the MP that had not been included thus far, including if new core elements and guiding principles were needed. CAPS researchers also conducted six focus groups of YBMSM on adaptation issues, and the advisory groups reviewed the results of these. The State of California and the California HIV/AIDS Research Program (CHRP), which required that the research all be conducted within the state, funded the study. The second research project was our TRIP Project (Translating Research into Practice). This is a study on how to translate an evidence-based intervention (MP) into practice in diverse settings. In order to learn more about adaptations that CBOs were making to the MP, the CAPS team-members visited four Black CBOs that were running African American implementations of the MP around the country and studied their adaptations. The CBOs were located in Detroit, Michigan; Newark, New Jersey; Atlanta, Georgia; and Orlando, Florida. We consider the adaptations that were consistent with the MP’s guiding principles and seem most successful to be “best practices.” They have been incorporated into this adaptation document. This study was funded through a grant from the National Institute for Mental Health. The third research project involves implementing an adaptation of the MP and testing its efficacy through a randomized, controlled study. The first part of that study involved taking the themes and issues that had emerged in the Translation Project and operationalizing them so that they could be incorporated into the implementation of the intervention. This was done through numerous conference calls among the research team that involved CAPS, Georgia State University, and University of Utah investigators. The project was then implemented in Dallas, Texas. There, as in all MP implementations, the Core Group developed the name of the project. The Core Group named the project, “United Black Ellument” (U-BE) to represent the strength that comes from weaving together the diversity of the YBMSM community into a strong, cohesive element. The unusual spelling is because the program is located in a historically Black Dallas neighborhood called Deep Ellum. As we pass this adaptation on to others, we decided to name the Black adaptation the same, except we changed the spelling to “Element” so as not to create confusion henceforth. The U-BE Project was funded by the Centers for Disease Control and Prevention (CDC). It should be noted that we intentionally use the term young Black men who have sex with men (YBMSM) throughout this document. However, a high proportion of the young men in U-BE and other MP implementations for young Black men self-identify as gay. Some, however also identify as bisexual, and others identify as same gender loving (SGL). Some of the men who identify as gay also have sex with women. As long noted, identity and sexual behavior do not necessarily match. But U-BE does not usually attract MSM who identify as heterosexual. They may be reached indirectly through interactions with and having sex with men who do identify as gay, bisexual, or SGL. U-BE does attract many young men who are not “out” to family, friends, and in the workplace. 4 Mpowerment Project United Black Element (U-BE): Adaptation of the Mpowerment Project to Young Black MSM The goals of MP are to address community building among YBMSM, increase safer sex among men infected and uninfected with HIV, and increase regular and This document frequent HIV testing. It is important not to simply promote “getting tested”, because the majority of should be used YBMSM have been tested before. Instead, the frequency in tandem with of testing is important to promote. We do not specify here the frequency of HIV testing since recommendations the Mpowerment from the CDC are in flux. In 2012, we are recommending implementation that YBMSM get tested at least every six months. But it manual. may be recommended in the future to obtain HIV testing more frequently. Hence throughout this document, where we discuss “frequent testing,” the message to MP participants should be more specific as to frequency. U-BE can be described in various ways. It is a risk reduction program, aiming at both HIV-negative and HIV-positive men. Men of both HIV statuses comprise the YBMSM community, and both need risk reduction messages. This is why the messages should not be “protect yourself from HIV.” Instead, it should be “protect yourself, protect your brothers, protect your community.” It is a community- level intervention, striving to reach all YBMSM in diverse social networks in a community through multiple channels and with different HIV prevention messages. It is a multilevel HIV prevention approach, since it aims at issues that exist within young men themselves (attitudes, beliefs, skills); interpersonal issues (sexual communication, boyfriend issues); social issues (changing norms around safer sex and regular and frequent HIV testing); and structural issues (providing a alternative space for men to come together and create a community that supports each other in many different ways). It is also a community mobilization approach, since it mobilizes YBMSM to build healthy communities, confront HIV, and spread messages to peer networks about the need to reduce unsafe sex and increase regular and frequent HIV testing. It mobilizes young men to take on these goals and spread these messages through their social groups. Finally, it is a condom distribution project since all venue-based outreach involves distributing condoms, social outreach events involves condom distribution, and the space has an abundance of condoms for men to take. Thus, the MP and U-BE are responsive to the U.S. National HIV/AIDS National Strategy. As previously noted, the intervention is meant to help all young men, regardless of HIV status, to reduce their sexual risk behavior. Specific messages to emphasize risk reduction among HIV-positive men can and should be disseminated throughout the community.