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 in PG county is extremely limited.
Internalized stigma is an important and understudied factor that can deter PrEP use among
BSMM, similar to the well documented associations between internalized stigma and several
HIV risk behaviors among SMM. Research has consistently shown the impact of stigma 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.
Internalized stigma and peer social support are potentially modifiable factors that may
directly impact PrEP acceptability and PrEP stigma; the associations between internalized
stigma and PrEP use are still notably understudied. Despite this, interventions promoting
PrEP use have largely not addressed internalized stigma as a potential barrier to uptake.
The goal of the proposed research is to design a peer-based community intervention
focused on addressing HIV stigma, HIV knowledge, and peer BSMM support to increase PrEP
initiation 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 through the use of peer-led activities and
discussions, often in a drop-in center. There have been several successful adaptations of
the MPowerment model in different settings. The investigators are adapting the model to
focus on improving PrEP initiation through focusing on peer support, and reducing
internalized stigma, including 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 in two ongoing MPowerment
programs, one in Falls Church, VA (suburban) and the other in Washington, DC (urban).
Aim 2. Conduct 32 in depth interviews to inform adapting an MPowerment intervention to
reduce internalized stigma 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 in PG County, based on the MPowerment model, with a focus on reducing
internalized HIV stigma and increasing social support and resilience.
