What predicts participation in community based HIV prevention programs for MSM? David M. Huebner, PhD, MPH Rae Jean Proescholdbell, PhD Diana Formoso, PhD Carol J. Nemeroff, PhD University of California, San Francisco Arizona State University

Background Several HIV prevention interventions for MSM have been developed and empirically supported Several HIV prevention interventions for MSM have been developed and empirically supported Community based organizations (CBOs) around the country are implementing interventions for MSM Community based organizations (CBOs) around the country are implementing interventions for MSM Little is known about who these interventions reach and what predicts participation in them Little is known about who these interventions reach and what predicts participation in them

Phase I -- Qualitative What services are being offered and what are the barriers and facilitators to participation in those services? Interviews and focus groups with a total of 23 diverse MSM Interviews and focus groups with a total of 23 diverse MSM –Special efforts to reach young, minority, IDU, and guys in rural counties Interviews with representatives from 9 CBOS Interviews with representatives from 9 CBOS

What kinds of service use occurs? Passive Services Passive Services Information Seeking Information Seeking HIV Counseling and Testing HIV Counseling and Testing Structured Services Structured Services Volunteer Opportunities Volunteer Opportunities

Barriers and Facilitators to Service Use Positive expectations Positive expectations –Services will be fun and interesting –You would learn something new –Staff will be respectful Negative Expectations Negative Expectations –Information about you would be spread to others –Your health insurance would be affected –People would assume you are doing risky things

Barriers and Facilitators to Service Use Personal Discomfort Personal Discomfort Being uncomfortable with… –Talking to a stranger about HIV –Talking to someone who is not gay about HIV –Being seen going into an HIV- related CBO

Barriers and Facilitators to Service Use Cues to Action Cues to Action –Having a friend test HIV+ –Getting sick –Being asked by a friend to get tested –Ending or starting a relationship

Phase II -- Quantitative Do our qualitative findings bear out in a large sample of MSM?

Recruitment Paper copies of survey distributed in local, free gay magazine Paper copies of survey distributed in local, free gay magazine Outreach to venues and events Outreach to venues and events Advertisements in gay and mainstream press, and on local websites Advertisements in gay and mainstream press, and on local websites Emphasis on oversampling Emphasis on oversampling underrepresented groups underrepresented groups

Participation Paper, online, or over the phone Paper, online, or over the phone 30 page questionnaire, requiring approximately 1 hour to complete 30 page questionnaire, requiring approximately 1 hour to complete Anonymous or confidential Anonymous or confidential $25 compensation or entry into a raffel $25 compensation or entry into a raffel

Sample Wave 1 (n = 709) Mean age 33, 13% were 21 or under Mean age 33, 13% were 21 or under 71% White, 13% Latino, 8% African-American, 6% Native American 71% White, 13% Latino, 8% African-American, 6% Native American 85% high school grad, 40% college grad 85% high school grad, 40% college grad 20% out to “no one” or “just a few people” 20% out to “no one” or “just a few people” Wave 2 (n = 399) 647 gave contact information (62% response) 647 gave contact information (62% response) Somewhat older, more out, and fewer African- Americans Somewhat older, more out, and fewer African- Americans

What gets MSM to use services? FactorsInfo-seekTestingStructuredVolunteer Sexual Risk Behavior+ Personal Discomfort -- Pos. Expectations ++++ Neg. Expectations - Cues to Action ++++ Demographics were also included in models Intentions To Use Services (Time 1)

What gets MSM to use services? FactorsInfo-seekTestingStructuredVolunteer Sexual Risk Behavior+ Personal Discomfort -- Pos. Expectations ++++ Neg. Expectations - Cues to Action ++++ Demographics and prior service use were included in models Actual Service Use (Time 2)

What does this mean for ASOs? Personal Discomfort Make private counseling available Choose ASO location that considers privacy of client Hire gay staff Hire ethnically diverse staff when serving ethnically diverse populations

What does this mean for ASOs? Positive Expectations Public relations matter! Publicize strengths of agency Remedy negative perceptions and public misconceptions

What does this mean for ASOs? Cues to Action: Men plan to and actually use services when... They are sick -Advertise at doctor’s offices and cold remedy aisles -Educate physicians about availability of services

What does this mean for ASOs? Cues to Action: Men plan to and actually use services when... A friend encourages them to -Bring a friend meeting or party Someone close to them finds out they have HIV or dies from AIDS -HIV positive men discuss their illness with others

What does this mean for ASOs? Cues to Action: Men plan to and actually use services when... A friend has engaged in risky behavior They end a relationship or start a new relationship -Pitch ads toward these events

Contact David M. Huebner Center for AIDS Prevention Studies University of California, San Francisco