CDC prevention project one of few for young MSM
CDC prevention project one of few for young MSM
First outcome data will be out next year
Prevention interventions geared toward young men who have sex with men (MSM) are few and far between, so clinicians and researchers will be watching with interest next year when some outcomes data are released for one of the most comprehensive prevention projects aimed at this population. The Community Intervention Trial for Youth (CITY), a research project of the Centers for Disease Control and Prevention (CDC) in Atlanta is an intervention that was developed specifically for MSM in the age range of 15 to 25 years.
"What is unique about this study is there have not been that many interventions evaluated in the literature developed specifically for young men who have sex with men," says Carolyn Guenther-Grey, MA, health communication specialist with the CDC. Guenther-Grey is the co-project officer for the CITY project.
The research study includes 13 communities. Through randomization, six were assigned to receive the intervention, and six were assigned to the comparison condition. One additional community is serving as a case study. The study communities target various racial and ethnic populations, Guenther-Grey says.
These populations are divided as follows:
• A CITY intervention being implemented in Seattle and a comparison group in San Diego target Asian and Pacific Islander young MSM.
• Four communities are targeting young Hispanic and Latino MSM. Of these, the intervention communities are Washington Heights and South Bronx in New York City, and Orange County in Los Angeles. The comparison communities are in Jackson Heights in Queens, NY, and the San Gabriel Valley in California.
• Communities targeting young African-American MSM include an intervention community in Birmingham, AL, and a comparison community in Atlanta, as well as a case-study community in Chicago.
• Also, four communities target young MSM of all races and ethnicity. These include intervention communities in Milwaukee, West Hollywood, CA, and Los Angeles, and comparison communities in Detroit and Minneapolis.
The CITY project began in October 1996, with formative research in 1997 and 1998. Investigators collected pre-intervention data from the intervention and comparison communities in the summers of 1999 and 2000, midintervention data in the summer of 2001, and end-of-the-intervention data this year. "Basically, they do data collection using a time-space sampling design where interviewers go to venues in the study communities where we’ve determined through formative research that young men can be found," Guenther-Grey says. These places include coffee houses, bars, clubs, and parks. Interviews are conducted in those places.
"At the end of the interview, individuals in the intervention and comparison communities are given referral information about small group workshops on HIV prevention in the community, lists of HIV prevention and social service providers, and the interviewers answer any questions they have," she adds. "Currently, there are HIV prevention activities in all of the intervention and comparison communities, so we are evaluating the effectiveness of an additional collection of HIV prevention activities in the intervention communities," Guenther-Grey continues.
"At the end of the study, it is our intention to provide resources to the comparison communities to do additional HIV prevention activities, and if the intervention proves to be effective, we will develop replication materials that will then be given to the comparison communities or to other communities, as well." The interventions were based on components shown to be effective in previous intervention studies, such as Mpowerment and Popular Opinion Leader, she says.
General overview
Until the project is complete, Guenther-Grey says she is unable to provide much detail about how the interventions work, but she does offer this general overview:
• Each intervention community develops a community health advisor (CHA) network of young MSM and their peers who receive a multisession training about HIV prevention. These CHA then talk with other people they know in the community, serving as opinion leaders and linking men to services. The community health advisors also become actively involved in other aspects of the intervention through the network.
• Intervention communities have small group workshops based on different topics, including negotiation of condom use and how to use condoms; and on the triggers for unsafe sex, including alcohol and drug use, and how to overcome trigger pressures. "These are sometimes led by staff and sometimes led by community health advisors," Guenther-Grey says.
• Social events are held with an HIV-prevention component, although the HIV focus might not be the primary reason for the event. "The HIV prevention activity might piggyback on other activities going on in the community, like a gay pride event or a poetry reading cosponsored by another organization," she says. "At one event, we had a poet reading poems and talking about HIV and HIV prevention as part of the evening event," she adds. "So we’re trying to find fun ways to build in HIV prevention and also giving young men a safe place to go to learn about HIV prevention."
• Intervention activities also include the distribution of brochures, posters, and fliers about HIV prevention.
Guenther-Grey says the goal is to complete data collection by September 2002, clean the data, and begin to analyze the results in December with a possible release of study outcomes in the spring of 2003.
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