Risk-reduction interventions have been developed for African American sero-discordant couples, African American or Latino men seeking treatment at STI clinics, and men who inject drugs(Johnson et al., 2009
; Darbes et al., 2008
). We know of no published studies reporting interventions developed specifically for African American heterosexual men, engaged in high-risk sexual activities and living in high prevalence areas, who are not bisexually active, seeking STI treatment or partnered with a known HIV-positive woman. We found promising preliminary evidence that the intervention was efficacious, with intervention participation associated with a statistically significant reduction in the number of total, new and unprotected female sex partners, as well as partner concurrency in the context of both primary and non-primary sexual partnerships. Although the proportion of men who had been tested for HIV increased between baseline and the 3-month follow-up assessment, this difference was not statistically significant, perhaps because the baseline level of testing was so high.
There are several limitations to this study that must be acknowledged. First, this single-arm study design did not include a control condition. Second, we were only able to assess short-term effects of the intervention; thus whether the effects are lasting or not is unknown. Third, because of our small sample size only bivariate analyses were conducted; a larger trial would enable multivariable analyses. Finally, we lost 17% of the sample to follow-up, due primarily to men being incarcerated during the follow-up window. This could have resulted in a bias towards finding a positive intervention effect, however there were no statistically significant differences in mean number of female sex partners, new female sex partners or unprotected female sex partners at baseline between men who had been incarcerated for any amount of time in the three months prior to baseline and men who had not. Future tests of this and similar HIV prevention interventions must build in procedures for following incarcerated men and include an attention control arm.
The results of this trial are encouraging, particularly the finding around sex partner concurrency, a sexual behavior that is thought to be driving the heterosexual epidemic among African Americans in particular(Adimora, Schoenbach, & Doherty, 2007
). Interventions for heterosexual men generally focus on decreasing unprotected sex and number of sex partners(Johnson et al., 2009
; Darbes et al., 2008
). The Straight Talk intervention focused specifically on concurrency, with interactive modules that illustrated how concurrency propagates HIV, as well as analysis of how social structures relate to sexual health outcomes. Although not a structural intervention, the session content reflected and analyzed the structured positions of African American men in society. For example, participants examined how African American men's social roles and identities, as fathers and men, economic realities and life experiences relate to concurrency.