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JMIR Public Health and Surveillance

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African American men -- Sexual health -- Web-based instruction, Health promotion, African American gay men -- Sexual health


Background: Human 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.

Objective: The 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.

Methods: The 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.

Results: A 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.

Conclusions: Our 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.


Copyright 2017 The Authors.

Originally published in JMIR Public Health and Surveillance

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