Black gay, bisexual, and other Black sexual minority men (BSMM) are a priority population and
experience the highest rate of new HIV infections in the United States. Maryland (MD) is an
HIV epicenter and ranks 4th in AIDS cases nationally; the state has several hotspots of HIV
and AIDS cases in geographically distinct areas, including urban, suburban, and rural
settings. Prince George's (PG) County is a majority Black suburban county (63% Black)
bordering Washington, DC, with the highest per capita income for Black people in the nation,
yet the second highest incidence and prevalence of HIV in the DC greater metropolitan area.
It is an understudied region in the "Ending the Epidemic" initiative to end HIV in the United
States. Despite the availability of PrEP for prevention and overall economic resources in
this area, uptake among BSMM remains low. Greater understanding of factors impacting PrEP
utilization among BSMM in this population and region of the U.S. are necessary for successful
HIV prevention for BSMM. Additionally, extant literature specific to PrEP use among BSMM in
PG county is extremely limited.
Internalized racism is an important and understudied factor that can deter PrEP use among
BSMM, similar to the well documented associations between internalized homophobia and several
HIV risk behaviors among SMM. Research has consistently shown the impact of racism and
homophobia on several HIV-related outcomes among SMM, including HIV stigma that deters uptake
of HIV prevention. In contrast, social support can facilitate HIV prevention behaviors among
BSMM. Internalized racism/homophobia, HIV stigma, and peer social support are potentially
modifiable factors that may directly impact PrEP acceptability and PrEP stigma among BSMM;
the associations between internalized stigma and PrEP use among BSMM are still notably
understudied. Despite this, interventions promoting PrEP use among BSMM have largely not
addressed internalized stigma as a potential barrier to uptake. Notably, internalized
racism/homophobia is more modifiable than experienced or anticipated racism/homophobia.
The goal of the proposed research is to design a peer-based community intervention focused on
addressing internalized homophobia, internalized racism, HIV stigma, and peer BSMM support to
increase PrEP initiation among BSMM in Prince George's County, MD. The investigators will
adapt the MPowerment peer-based model: This is a CDC-developed evidence-based intervention
originally designed to reduce sexual risk and improve peer support among SMM through the use
of peer-led activities and discussions, often in a drop-in center that is a safe space for
young BSMM.31,32 There have been several successful adaptations of the MPowerment model in
different settings of SMM. The investigators are adapting the model to focus on improving
PrEP initiation among BSMM, through focusing on peer BSMM support, and reducing internalized
racism, homophobia, and HIV stigma through peer-led events and activities. The following are
our aims:
Aim 1. Using ethnographic methods (participant and direct observation), study peer-peer
interactions/exchanges and HIV prevention communications among BSMM in two ongoing MPowerment
programs, one in Falls Church, VA (suburban) and the other in Washington, DC (urban). As the
PI is a BSMM well connected to these organizations, he has unique advantages in conducting
these ethnographies.
Aim 2. Conduct 32 in depth interviews to inform adapting an MPowerment intervention to reduce
internalized racism/homophobia and increase PrEP uptake among BSMM in PG County. This would
inform intervention site selection, promotion materials, and design of events and activities.
Aim 3. Pilot test a community-based pretest-posttest intervention (n=130) to increase PrEP
uptake among BSMM in PG County, based on the MPowerment model, with a focus on reducing
internalized racism/ homophobia/HIV stigma, and increasing social support and resilience.