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Efficacy of a culturally congruent HIV risk-reduction intervention for behaviorally bisexual black men: results of a randomized trial

Objectives:Black men who have sex with men and women (MSMW) experience high HIV rates and may not respond to interventions targeting gay-identified men. We tested the efficacy of the Men of African American Legacy Empowering Self (MAALES), a multisession, small-group holistically framed intervention designed to build skills, address sociocultural issues, and reduce risk behaviors in black MSMW. Design:From 2007 to 2011, we enrolled 437 black MSMW into a parallel randomized controlled trial that compared MAALES to the control condition, a single, individualized HIV risk-reduction session. Methods:Participants completed surveys at baseline, 3 months, and 6 months postintervention. We used multiple regressions to compare risk behaviors at follow-up between the intervention and control groups while adjusting for baseline risk behaviors, time between assessments, other covariates, and clustering. We used inverse probability weighting (IPW) to adjust for loss-to-follow-up while carrying out these regressions with the 291 (76.4%) randomized participants who completed at least one follow-up. Results:Participants were largely low-income (55% reported monthly incomes <$1000); nearly half had previously tested HIV positive. At 6 months of follow-up, unadjusted within-group analyses demonstrated reduced risk behaviors for the MAALES but not the control group. Adjusted results indicated significant intervention-associated reductions in the numbers of total anal or vaginal sex acts [risk ratio = 0.61; 95% confidence interval (CI) 0.49–0.76], unprotected sex acts with women (risk ratio = 0.50; 95% CI 0.37–0.66), and female partners (risk ratio = 0.56; 95% CI 0.44–0.72). Near significant reductions were observed for number of male intercourse partners. Conclusion:The MAALES intervention was efficacious at reducing HIV risk behaviors in black MSMW.