Previous studies have documented the elevated incidence and prevalence of HIV infection in African American and Latino men who have sex with men (MSM) as compared to White MSM. Despite significant declines in HIV infection rates among MSM since the early years of the epidemic, MSM continue to be the group at highest risk for HIV, accounting for an estimated 42% of all new infections in the United States today.1 Young MSM, African American MSM, and Latino MSM are at particularly high risk for HIV infection. The Young Menís Survey (Phase I), a study carried out in seven U.S. cities in 1994-1998 among young MSM aged 15-22 years, found a significantly higher prevalence of HIV among African American and Latino MSM, compared to White MSM (14.1%, 6.9% and 3.3%, respectively).2 The Young Menís Survey (Phase II), conducted in 1998-2000 with MSM aged 23-29 years, documented an even greater disparity, with HIV prevalence 32% among African American MSM, 14% among Latino MSM, and 7% among white MSM.
Given these statistics, new studies are needed to understand why some MSM of color contract HIV, while other Black and Latino MSM remain free of infection. Building upon the work of the Young Menís Survey and other epidemiological studies over the past decade, the Brothers y Hermanos study conducted a formative research phase (years 1 and 2) to identify ethnic- and race-specific psychological, social, cultural, and environmental constructs that are associated with risk behavior within Black and Latino MSM populations. Focus groups and in-depth qualitative interviews elucidated these constructs and identified the salient variables to be included in the epidemiological survey phase in Years 3 and 4.
The objectives of the formative research phase of Brothers y Hermanos were to:
- Identify HIV risk-promoting and risk-reducing cultural, social, environmental and psychological factors within populations of Black and Latino MSM through interviews and focus groups with key participants and systems representatives;
- Delineate variables and specify appropriate language for questions to be used in the epidemiological survey;
- Inform the epidemiological research phase of the study;
- Generate preliminary in-depth knowledge of factors that can be tested in community-based HIV prevention trials.
In Los Angeles County, qualitative data were collected through focus groups, in-depth qualitative interviews, and field enumerations. Focus groups were conducted separately with three groups of men: adult (18 and older) self-reported HIV-positive, adult self-reported HIV-negative, and young (15-17 year old) Latino MSM. In-depth interviews were carried out with Latino MSM ("key participants") and with local officials or service providers ("systems representatives") who have expertise with the Latino MSM community. Field enumerations, including brief street interviews, were undertaken to identify the universe of potential recruitment sites for recruiting diverse segments of the Latino MSM population in the epidemiological survey phase. Additionally, a community advisory board (CAB) was assembled.
The CAB is composed of community members who have provided input on the study instruments and will help advise the implementation and interpretation the qualitative research. Interview and focus group guides were developed in conjunction with CAB members at each study site (New York, Philadelphia and LA) to ensure that the language used in the instruments were culturally and linguistically appropriate for the target populations. Instrument content reflected research gaps found in the scientific literature and feedback from two expert panels of investigators familiar with HIV/AIDS research in Black and Latino MSM communities.
Daniel Rivas, Study Coordinator, 213-637-8463
Trista Bingham, Principal Investigator, 213-351-8175
- Centers for Disease Control and Prevention. (2000) HIV/AIDS Surveillance Report 2000, 12.
- Centers for Disease Control and Prevention. (2001) HIV incidence among young men who have sex with men Ė seven U.S. cities. MMWR, 50(21):440-444.